Sunday, April 13, 2008

Top 10 Trends in Healthcare

America is undergoing a dramatic shift in healthcare. Actually, ten distinctly different shifts.
Although the changes are unsettling, and will cause dislocations in our economy, the overall trends are positive and will help us all be healthier and wealthier when it all shakes out.

1. Western Medicine Costs Continue to Rise

It's hard to imagine, but the cost of going to a regular MD or hospital is going to get more and more expensive. This is not because doctors or hospitals are getting greedy, but instead because their own costs are rising every year. Malpractice insurance for risky surgical procedures, pharmaceutical drug reactions and deaths with accompanying lawsuits, complex medical equipment for diagnostic testing – everything is rising dramatically in cost. Pharmaceutical drug costs will continue to escalate also, leaving consumers holding the bag, because...

2. Health Insurance Opt-Outs Surge

For many years, corporations and small businesses have provided health insurance as an employee benefit. Often, employees would choose a job based on who offered the best health insurance. No longer. Small businesses have almost completely opted-out of the insurance game, and large corporations are not far behind. General Motors complains that health insurance costs them more per year than steel for their cars. In a few years, health insurance through your employer will be only a memory. Everyone will be buying health insurance the same way they buy home insurance or car insurance – independently.

Because of this shift, consumers will begin treating health insurance the same way they treat car and home insurance. Which is to say, they will treat it like INSURANCE.

Today, many Americans run to their doctors for even the smallest maladies, and they expect their health insurer should pay for everything. In fact, they're incensed when they don't. “What, you're not paying for this bottle of antibiotics for my kid's ear infection? How terrible!”

This is opposite of how we treat car insurance. Imagine expecting your insurer to pay for oil changes, car washes, pockmarks in the paint job, a broken cupholder. Can you picture it? Of course not. It would be ridiculous.

Yet, with health insurance, it's been okay. Why? Because the employer is picking up the tab. Not anymore, they're not.

As a result, Americans will pay more attention to preventive healthcare, like regular exercise, good diet and meditation, etc. They will also do more cost comparisons between all their healthcare options, including a trip to the doctor, or...

3. Alternative Medicine Becomes the Dominant Healthcare System in America

I feel bad calling this a future trend, since this has almost already occurred. Alternative medicine, including naturopathy, hypnotherapy, Chinese medicine, chiropractic, yoga, etc. is fast overtaking Western medicine (drugs and surgery) as the dominant healthcare system of America.

Several studies have shown that Americans spend more out-of-pocket on alternative medicine than on Western medicine. They've also shown that people are making more trips to these alternative practitioners than they are to regular MDs. These are positive developments. The downside is that people are reticent to mention their alternative therapies to their doctors, because they're afraid of disapproval by their doctor.

But the trend is clear. Alternative medicine is often less expensive (especially outside of insurance), equally effective and produces less harmful side effects, as was evidenced by the flurry of pharmaceutical drugs this past year that were removed after being prescribed to hundreds of thousands of patients.

People's trust in Western medicine is diminishing, and their relief in finding alternatives is rising.

Major institutions are now doing large numbers of studies on alternative medicines, including herbal remedies, bodywork, meditation, dietary changes and many others. Randomized, controlled studies are available on almost every type of alternative healing practice, and they typically show good results.

The rise of alternative medicine and the opting-out of employer-funded health insurance has led us inevitably to an era of...

4. Consumer-Driven Healthcare

People are making their own choices in healthcare and health insurance. They want to make their own decisions.

This is extremely positive. One study after another shows that hospital patients who are disruptive, picky, nosy and non-compliant are the ones who fare best with any surgery or recovery from illness. The patients who are compliant and put their fates in the hands of their doctors are the ones who fare most poorly. Taking charge of one's health is part of consumer-driven healthcare.

This term also refers to how people are deciding to use whatever treatments they think will work best, based on their own research. Fewer people simply accept their “doctor's orders” and instead they find out for themselves what is available and make informed choices. This also means they are deciding to use a different kind of health insurance, which is more compatible with their free-will healthcare style...

5. High-Deductible Health Insurance and Health Savings Accounts (HSA)

As corporations drop their employees' health plans, the employees are choosing to buy high-deductible health insurance policies, which are much cheaper.

In fact, a high-deductible policy ($2,500 deductible or higher) is almost always so much cheaper, that even if you had to pay the entire deductible yourself every year, you'd still save thousands of dollars. The monthly premiums are reduced MORE than the amount of the deductible.

Along with high-deductible policies, people are choosing to use the Health Savings Account (HSA), introduced in 2003. This is a tax-deductible savings account that can be used for any medical treatment (Western medicine, actually), which is basically a tax savings for everyone who buys their insurance independently.

High-deductible policies and HSAs allow people to have Western medicine waiting in the wings when they have serious health problems that require expensive drugs, tests and surgery. But until then, they are able to use alternative medicine as the best service for prevention and small day-to-day health problems.

Alternative medicine provides a “first line of defense” while Western medicine provides the expensive, dangerous, but necessary backup.

Since alternative medicine has taken such a major role in healthcare, the state and federal laws have had to adjust, which has meant...

6. The Rise of Health Freedom Laws

Health freedom is a term applied to a particular kind of legislative bill. It is a bill that allows alternative medical practitioners to practice their healing arts, as long as they stay out of the areas where extensive Western medical training is required:

  • performing surgery
  • prescribing pharmaceutical drugs
  • administering injections (like vaccinations)
  • knowingly contradicting an MD's orders

If alternative medical practitioners are caught doing any of these, they can be arrested for practicing medicine without a license. But otherwise, they can use any other type of healing art, including bodywork, dietary changes, movement therapies, hypnosis, etc. to help their clients.

This bill is needed in many states, because current laws state that no one can practice medicine except medical doctors, and the definition of practicing medicine is anything that helps people with their health! This means that if someone has a cold, and they go to a massage therapists who recommends echinacea, that massage therapist is breaking the law! Ridiculous? Practitioners have been shut down in many states for doing less.

Health Freedom laws are common sense. They've been passed in four states already – Minnesota, Rhode Island, California and Idaho. These states have had excellent results from these bills, including patients from neighboring states making trips to their states to seek relief from health problems. Can you say “boost to the economy?”

For more information about Health Freedom initiatives, visit the National Health Freedom Website.

With Health Freedom information, and alternative medical options available, it is only natural that people turn to...

7. The Internet As a Healthcare Information Resource

The Internet has become the first stop for someone who has a health concern. Feeling low? Do a search on depression remedies on the Internet. Just been diagnosed with cancer, and the doctor says it's chemotherapy or die? Jump on the Internet and see what your other options are.

Of course, the Internet has its benefits and its problems. There is a tremendous amount of misinformation about healthcare on the Internet. Much of it comes from well-meaning entrepreneurs who have been sucked into a multi-level marketing (MLM) scheme and are trying to pitch some health elixir or other. A second source of health misinformation comes from the Western medical establishment, who seek to discredit alternative medical therapies that could take significant revenues away from their invested therapies. A third source of misinformation comes from the anecdotes of individuals who experienced relief from one therapy or another, but who do not (and cannot) actually represent a proven cure to a particular health problem.

Even with all these caveats, the Internet's influence in healthcare decisions will gain momentum. People will understand the “good sources” and “bad sources” of information and new portals will crop up that separate the wheat from the chaff.

The reason people are turning to the Internet in such numbers is due to a lack of trust...

8. Distrust in Existing Medical Institutions

At one time, you could hold no position of higher trust than to be a doctor. My wife's father was a doctor in a small town in Ohio. When he died, the funeral was packed with his patients over the years. People appreciated his caring and his dedication to keeping them healthy.

Now, doctors are viewed with suspicion. Will my doctor let me die by not revealing an alternative therapy that could help me? Is my doctor getting kickbacks from the cute, young, female pharmaceutical rep who visits him twice a month?

The system has gained the pallor of corruption, even when it's not really true. Big medicine has become big business, and the number one concern is no longer the patient, it's dollars and cents.

But hospitals and doctors are not the only things that Americans distrust...

9. Distrust of Socialized Medicine

People in government and in society seem to feel that some brand of socialized medicine will be the magic solution for America's healthcare problems. The “single payer system” of healthcare, successful in other countries, must be implemented here, they say.

But America is a different kind of country, from its very beginnings. Americans praise the independent spirit, the entrepreneur, the underdog.

Socialized medicine will not work in America. And Americans know it. They do not want a government-run system. What is the least efficient organization you can imagine? It's the government. Do you really want a government worker making decisions for you about healthcare?

Yes, America needs to find a way to insure every single person in this country. But socialized medicine is not the cure for this illness. Having been born in Canada and living there for the first twenty-eight years of my life, I can say that Canada's socialized medicine program leaves much to be desired. It does cover every person, but in a way that benefits no one.

I understand that the person in the middle of this entire crisis, the professional who has the most to gain or lose, is the doctor, the general practitioner. They will be devastated by a socialized medicine system, and they will also be affected greatly by the other trends in this article.

Because of this, I see the emergence of a final trend...

10. Doctors Incorporate Alternative Medicine Into Their Practices

Doctors will have no choice but to use pieces and parts of alternative medicine in what they do day-to-day with patients. “The customer is always right,” as they say, and the customer definitely wants a choice.

Although doctors are increasingly using alternative medicine in their own practice, and hiring alternative practitioners to work in their offices, the independent alternative practitioner will still be the rule, not the exception. There are just too many alternative practitioners (massage therapists, chiropractors, yoga instructors, etc.) for doctors to absorb everyone. And people will want a choice. A Western medical experience, or perhaps an alternative medicine experience.

And a choice they will receive.

The Western medical practitioners who are clearly leading the way are nurses. Nurses are much more open to alternatives than doctors, and they are increasingly opening their own offices, as nurse-practitioners sometimes, and treating patients with a wide variety of healing methods. Patients appreciate the nurses Western medical knowledge, and also their openness to a new set of options.

Overall, the outlook for healthcare is extremely positive for everyone involved. Tremendous change, yes. But upheaval can create some wonderful new circumstances.

Daryl Kulak is the author of Health Insurance Off the Grid, a book that provides a simple, effective plan to reduce insurance costs for the self-employed and underinsured. The book puts the new Health Savings Account (HSA) together with alternative medicine to create a workable, cost-effective plan for many Americans. The book is available at this Website.

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Top Ten Trends in Healthcare

10 Big Problems We Must Overcome to Make Alternative Medicine the Major Healthcare System

(photo courtesy of feelgood_paradise at Flickr)

There is no doubt that alternative medicine is becoming a popular option among patients in the U.S. and Canada. We love it! We are choosing it in greater and greater numbers, even though we have to pay for many of these services out-of-pocket. Americans spend over $27 billion on out-of-pocket expenses on holistic healthcare each year. Fully one-third of us use some form of holistic services, and total visits to holistic providers exceed the number of visits to medical doctors each year.

But Western medicine is still considered the “major healthcare system” in Canada and the U.S. What will change this?

I've discovered that there are at least ten factors holding holistic healthcare back. In this article, I'll outline each factor, in the hopes that this will spur you, my readers, on to action to fix each of these ten issues.

#1 – Get Organized

Holistic healthcare, for all its popularity among clients, is extremely disorganized. In my city of Columbus, Ohio, we have various cliques of practitioners who isolate themselves from others and seem to consciously limit communication and interaction with other practitioners. I know this is true in many communities. Holistic healthcare must become a “profession.” It must have univeral standards, professional associations across modalities, and lots of professional networking. This is what makes Western medicine so powerful. They have a very organized and powerful professional association, in the American Medical Association (AMA) and they have strong links in to all levels of government and community. Holistic healthcare must do the same, although we must do it in our own way. We are an industry. We are professionals. We must act this way. We must get organized, professionally and politically.

#2 – Change the Laws

The laws in many U.S. states and Canadian provinces discourage use of holistic services. Here in Ohio, everyone from naturopaths to reflexologists to nutritionists are illegal, according to the letter of the law. It's antiquated, yes, but the licensure boards feel they must enforce these antiquated laws and they often do, shutting down legitimate practitioners who are helping their clients and not harming anyone, just because the law is wrong.

We've organized the Health Freedom Coalition of Ohio here in this state, and many other states have similar groups. Check the national Health Freedom Website for groups in your area. Join us in changing the laws to reflect the needs and wants of holistic healthcare patients and practitioners. As far as I know, no Health Freedom groups exist in Canada. However, international laws like those coming from Codex Alimentarius are threatening healthcare freedoms everywhere.

#3 - Reject the Gold Standard of Controlled Trials

Holistic healthcare is, by definition, holistic. Controlled trials, also called randomized, double-blind, placebo-controlled controlled trials, are meant to measure patients' reactions to drugs. In a vain attempt to “fit in,” many holistic healthcare advocates are submitting holistic practices to these controlled trials to provide “objective proof” to Western doctors that these practices work.

Using positive results from controlled trials is a reasonable short-term strategy to making holistic healthcare pallatable to Western doctors and their followers, but it will not work in the long term.

The reason it can't work for holistic practices goes back to the nature of holism. A holistic practitioner treats a patient as a “whole person – body, mind, spirit, environment.” These aspects of the person are inseparable. You can't reduce a person down to a single organ, a single disease, or a single symptom. And, unfortunately, reductionism is inherent in the nature of controlled trials. Each controlled trial attempts to eliminate all “outside causes” and reduce the study down to “the effect of one drug on one part of the person.” This is categorically impossible in a holistic perspective.

Holistically, energy fields exist. We must take a person's energetic profile into account with their physical body. We must understand the person's relationships in the family and society. We must know their history. We must understand their mental state.

No controlled study can eliminate all these factors. Controlled trials are not the way to test holistic healthcare modalities. We must come up with a better way of testing our modalities, which is every bit as scientific and rigorous as controlled trials, but does not have the downsides.

#4 - Patients Need Road Maps

Holistic practitioners must be able to provide each patient with a road map of treatment, given the patient's problems and circumstances. This is a marketing issue. If the practitioner asks the patient just to “play along” with the practitioner tries this and that, patients will not likely stick with the program, because there really isn't a “program” that they can see.

Practitioners need to give patients an understandable set of steps that practitioner and patient will take together that are likely (although not guaranteed) to solve the problem at hand. The roadmap will include the services the practitioner can provide, the services needed from other practitioners, and the activities the patient needs to accomplish.

#5 - We Need Truly Integrative Clinics

A true integrative clinic is not just a bunch of practitioners sharing the rent and referring patients.

True integration means that a patient sees themself as a patient of the clinic, not a patient of a particular practitioner. The patient expects that the clinic will provide him with the right services at the right time, and feels that he is supported and led through the maze of various modalities to the right ones for his situation, background, needs and beliefs.

This means that the clinic has what I call a “holistic patient manager,” who is independent of holistic modalities and who's sole purpose is to guide the patient through the process of getting healthier. The patient manager works with the patient to create a road map (see Point #4) and answers their questions and concerns throughout the process.

It also means that the practitioners working in the clinic have faith in the overall processes, and are constantly giving their input to improve it. It means that practitioners compare notes on each patient and strive to give consistent advice to the patients (NOTE: HIPAA compliance on patient record confidentiality will be necessary.)

#6 – Practitioners Must Serve Their Clients' Need Above All

I've noticed that many practitioners feel that the main reason they are practicing their particular modality is for the love of that modality. For instance, a massage therapist feels that the whole reason for her practice is that she can “do the work she loves.” While it is important to do what you love, the main reason for a holistic practitioner's business is to serve clients. When times get tough, and the practitioner needs to do things that they don't love (taking out the laundry, collecting money, etc.), this incorrect focus gets messy. A practitioner must remember, first and foremost, to focus on the needs of the clients, and then to focus on enjoyment of the work. If this is backwards in the mind of the practitioner, the business will not survive.

Here's a test to see if your business is client-focused or modality-focused. Look at your list of services. If the list is simply a list of modalities (massage $50/hour, reflexology $60/hour, nutrition counselling $70/hour, etc.) then you are modality-focused. If your list of services is a list of client problems (fatigue revitalization $200, headache relief $250, etc.) then you are client-focused.

#7 - Health Insurance Must Change to Include Holistic Healthcare

The day that health insurance begins to include holistic practices will be a major step towards our becoming the major healthcare system in North America.

Health insurers are well-advised to include holistic practices like naturopathy, massage therapy and herbal remedies into their programs. Their insured clients will be healthier, will cost less, and happier.

However, there is a limit to what insurance should provide. Insurance, by definition, is meant for expenses that we (the insured) can't pay for ourselves. That means that when a car accident occurs, and my legs are broken in five places, this is a time for insurance. When I am diagnosed with multiple sclerosis, insurance needs to be there for me. When I fall down the stairs and need an emergency room visit, insurance should help.

But insurance is NOT for day-to-day health needs. The yearly or twice-yearly trip to the doctor or naturopath should NOT be covered by insurance. Monthly massage therapy appointments should not be included in health insurance, unless they are a defined part of a recovery from injury or trauma.

Why? Because if we include regular medical needs in our insurance plans, the costs will be unaffordable. There is no reason to pay your insurance company extra money, only to have them pay it right back to your doctor, naturopath, massage therapist or nutritionist. It doesn't make sense. The insurer will take their cut out of the money and you'll be paying much more for that regular care than if you had paid the practitioner out-of-pocket. Insurance has no place in the world of day-to-day prevention, health maintenance and wellness.

I feel very strongly on this point, and I hope that insurance companies take heed as they begin to step into the world of holistic healthcare. I've written a book on this subject called "Health Insurance Off the Grid," which you can reference at the bottom of this article.

#8 - Separate Holistic Healthcare From New Age Religion

To look at a person holistically, it means that you see the person's body, mind and spirit. The last one, spirit, seems to say that religion must somehow be involved in healthcare.

That assumption can be a costly mistake. Many Americans and Canadians are frightened of holistic healthcare for exactly that reason. They think the holistic practitioner will try to “convert them” to some new and exotic religion , which they don't want. They're perfectly happy being Protestants, Catholics or Muslims. They don't want religion encroaching on their healthcare, they just want a reiki session.

Practitioners must understand this. Religion of any type, but especially new age religions, must be kept away from the practices of holistic healthcare. Yes, spirit is involved in any type of healing, but that doesn't mean the practitioner needs to feature it front-and-center and go on and on about their particular religious icons, symbols and beliefs.

Mixing religion and healthcare is bad for business. I urge holistic practitioners to separate the two. Holistic healthcare will never thrive in the U.S. or Canada unless it is decoupled from religion.

#9 – Practitioners and Clinics Must Focus on Quality Marketing

The majority of holistic practitioners and clinics I've been exposed to have poor marketing practices. There often is no marketing plan, and the practitioners and clinic owners often have a distaste for the overall idea of marketing and sales.

No business can survive without high-quality sales and marketing. There does not need to be anything distasteful about marketing or sales. In fact, it is easy to see that these activities are actually “acts of love” in many ways.

I urge all holistic practitioners and clinic owners to learn everything possible about marketing and sales. The best sales training I've found is at the Sandler Sales Institute. You will not find a more “holistic approach” to sales. I can also say that the Sandler approach is decidedly a low pressure approach and something that anyone can feel comfortable working with in a holistic practice. Locally, here in Ohio, I can say for certain that the best sales training affiliate of Sandler Sales is Growth Resources, serving Central Ohio.

#10 - We Need High-Quality, Long-Term Apprenticeship Programs

In China, when a person decides to become a practitioner of Traditional Chinese Medicine, they go to school to learn the basics and then they become an apprentice of an experienced practitioner for many years before striking out on their own. The same is true for ayurvedic practitioners in India.

Although North America has a variety of schools teaching various modalities from massage to acupuncture to polarity therapy to energy healing, we do not have any long-term apprenticeship programs. Holistic healthcare modalities that I've encountered are multifaceted, complex therapies that often require years to master. The best practitioners are those who have practiced for many years, and who have attended one training class after another, year after year. They also usually found a mentor who was willing to teach them the subtle details of the modality, the art of it.

If we are to produce high-quality practitioners, we need a strong apprenticeship program like China and India. This will take time to create and may be resisted by young practitioners who wish to jump into independent practice too quickly. But it's a very necessary step to making holistic healthcare more popular in North America.

These are my thoughts about the ten major problems facing holistic healthcare today. What can you do? Can you join a Health Freedom group in your area? Can you help your holistic clinic become more client-focused? Can you help to change health insurance to include holistic alternatives?

Please consider what you can do to help holistic healthcare to become the major healthcare system in North America. This is something that will save many lives, people who are now dying because they aren't being helped by drugs and surgery, and yet aren't aware of the options.

Daryl Kulak is the author of "Health Insurance Off the Grid", a book to help people buy health insurance that will maximize the out-of-pocket money available for holistic services and products.

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