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Five Impotent Points About the Best cheap Health Insurance.
1. My Blogs News Alert for: Family Insurance. 2.
How To Choose Your Life Insurance Company . 3. How To Choose Your
Best inexpensive Health Insurance. 4. What you should know about
a Best reasonable Life Insurance. 5. Family Insurance - Not Hard
With Help. Affordable Life insurance - it seems, especially today,
those words just do not belong together in the same sentence. Family
insurance monthly premiums have become the biggest single expense
in our lives - surpassing even mortgage payments. In fact, if you
have any permanent Health problems, such as diabetes, or have had
cancer at one time in your family history, your monthly cost could
easily be more than the house and car payment combined. Shopping
for within your means Life insurance can certainly be an eye-opener.
If you have always had a Family insurance benefit where you work
- especially a state or federal employee - and now have to buy your
own, you may not be able to afford the level of Health insurance
coverage you have become used to. reasonable Health insurance, however,
is definitely available - if you know how and where to look. When
you are looking for Affordable Family insurance, you want the lowest
cost per year that will fit your budget, of course. But, even more
importantly, you want a friendship that has a good record for paying
without fighting with you on every detail. Just as there is a car
for just about any budget, there is also inexpensive Life insurance.
You may not be able to afford a Cadillac policy - but then you probably
do not need all the frills anyway. Shopping for Life insurance on
the internet is the easiest and best way to find within your means
Family insurance. Here are five reasons why. 1. You do not need a
local agent to help you submit the claims for Health insurance. The
medical provider does it for you. You save money because the Family
insurance concern saves money by not paying the agent commission.
This could amount to an 8% to 12% savings to you. 2. All the top Health insurance companies are at your fingertips on the internet. Most local agents can only quote you from the few companies that they represent. They may not offer you what is best for you financially or health-wise but only what they happen to have available. 3. Life insurance companies have to be extremely competitive because it is so quick and easy to compare them with their competitors on the internet today. In the past you would have had to visit physically eight to ten agents to do a similar comparison. Most folks just did not have the time or desire for that. 4. You can change your coverage, deductibles, and payment options with just a few clicks rather than going through the paperwork delay with a local agent (and then finding out he/she made a mistake - more delay). 5. Charging to a credit card means you are not going to forget a payment and be without insurance. Also, it gives you another 30 days before you actually have to pay. Also, many companies today give an additional discount for auto-pay. The key, however, to finding cheap Life insurance is realizing that the purpose of any Family insurance is to protect you from a major financial loss - not to protect you from spending small money on clinic visits and sliver removal. These small expenses may be cumbersome but they generally will not hurt you. It is the $100,000 heart operation that will break you. That is the financial disaster Health insurance was originally designed to prevent. Also, keep this in mind. Family insurance, as with any insurance, is a gamble. You are gambling that you will draw out more than you pay in. Your Life insurance corporation is gambling they will pay out less. The odds are in their favor for two reasons. They have all the facts for millions of families to average out, so they know the risk in advance. Also, they get to set the rules and the prices. The higher you set your deductible, the more risk you take. This is not a bad thing at all. You will most likely be the winner in the long run. Yes, finding cheap Health insurance is much easier than most people think. Taking more of the risk with higher deductibles, spending a little time on the internet comparing eight to ten different companies, and deleting coverage that you will not likely need (such as maternity for many folks) will make it very possible to find your own within your means Health insurance.
How to Find Affordable Health Insurance
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Health Insurance - Our free service
provides you with quick access to health care plans and affordable
health insurance quotes from leading medical insurance companies.
Get your free HEALTH INSURANCE QUOTE Welcome to HealthInsuranceFinders.com.
Find low cost health insurance coverage or browse through our
extensive information resources on all major health-related insurance
plans, including short-term, long-term, travel, international,
dental, Medicare supplemental, student, family, individual, and
group health insurance. Health Insurance Quotes Today\'s online
market makes finding the most affordable health insurance easier
than ever. Unlike other insurance websites, healthinsurancefinders.com
allows you to obtain health insurance quotes from multiple major
insurance carriers and local agents in your state. This allows
you to compare quotes and find cheap health insurance plans that
meet your budget and health needs. Our service is free to you.
Medical insurance premiums are determined by health insurance
companies in accordance with state regulations, so you will not
find a lower premium for any of the major medical health insurance
plans quoted by agencies listed on our website. No one can offer
a lower premium. The premium quotes would be the same if you were to
purchase your medical insurance directly from the insurance company,
so take advantage of the options that our service offers. Affordable
Health Insurance Our goal is to not only to provide you with
the largest selection of medical insurance options, but also
to provide you with the information you need to make educated decisions.
Knowledge and variety are the keys to finding affordable insurance
coverage. Whether you are looking for family health insurance for you
and your family or group health insurance for your small business,
we provide access to quotes and information to help you determine how
to choose the best plan and utilize your coverage. Did you know that
short term health insurance is available to fill in gaps in coverage
while you switch jobs or search for a permanent plan, so you never
have to be without coverage? Get a free health insurance quote and
research the risks of temporary health insurance before you decide.
Most major insurance plans do offer supplemental dental insurance ,
but purchasing a stand-alone policy may be more affordable if you understand
the different plan types, compare premiums, and choose wisely.
If you are a student heading off to college, you should review our
step-by-step guide to student health insurance to ensure that you are
choosing the best and most affordable option. Are you on Medicare or
caring for someone whose current health care benefits do not meet their
medical costs? Consider Medicare supplemental insurance to help cover
the expenses not included in traditional Part A and Part B. Health
insurance does not stop at home. Whether you travel frequently or are
just planning a one-time trip, you should consider obtaining travel
health insurance . If your job or lifestyle has you traveling for more
than a year, we also provide quotes for international health
insurance . Both types of insurance cover typical health care needs
on foreign soil as well as special needs unique to traveling such as
medically-assisted return trips. Medical Insurance Information - Consumer
Resources, Advice, and News Articles We encourage you to take advantage
of the years of experience and research that we have in this market.
Throughout this site you will find useful information to assist you
in all aspects of health insurance. We offer how-to guides on numerous
subjects like How To Choose a Health Plan and How To Utilize Your Health
Coverage . Follow our suggestions for researching a health insurance
company by starting with our insurance company profiles. If there
is an answer that you seek and cannot find, please submit an inquiry
and our staff will help find the answer. Quotes & Information
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Health insurance helps protect you
from high medical care costs. Many people in the United States
get a health insurance policy through their employers. In most
cases, the employer helps pay for that insurance. Insurance through
employers is often with a managed care plan. These plans contract with
health care providers and medical facilities to provide care
for members at reduced costs. You can also purchase health insurance
on your own. It usually costs you more than employer-based insurance.
People who meet certain requirements can qualify for government health
insurance, such as Medicare and Medicaid . If you do not have health
insurance, you must pay your medical bills directly or rely on health
care providers or organizations that donate care. Start Here Health
Insurance: Understanding What It Covers (American Academy of Family
Physicians) Also available in Spanish Health Insurance: Understanding
Your Health Plan\'s Rules (American Academy of Family Physicians) Also
available in Spanish Top 10 Ways to Make Your Health Benefits Work
for You (Dept. of Labor) Basics Learn More Multimedia & Cool Tools
Overviews Latest News Related Issues No links available Research Reference
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JAMA Patient Page: Health Care Insurance: The Basics (American Medical
Association) Also available in Spanish Latest News Many Kids with Private
Insurance Missing Vaccinations (08/07/2007, HealthDay) Uninsured
Americans Raise Medicare Expenditures (07/11/2007, HealthDay) As Costs
of Drugs Shift to Consumers, Spending Drops (07/03/2007, HealthDay)
New CDC Report Documents Percentage of People without Health Insurance
(06/25/2007, Centers for Disease Control and Prevention) More News
on Health Insurance Related Issues Emergency Care -- Know What Your
Health Plan Covers (American College of Emergency Physicians) Employer
or Union Coverage (Centers for Medicare & Medicaid Services) Health
Insurance - Provision of Mental Health and Substance Abuse Services
(Center for Mental Health Services) Health Savings Accounts: Is an
HSA Right for You? (Mayo Foundation for Medical Education and Research)
How Your Bills Get Paid: Medigap (Centers for Medicare & Medicaid
Services) Insurance (Dental Benefits) (American Dental Association)
Life Events Impact Health Benefit Needs (Dept. of Labor) Medicare and
Other Health Benefits: Your Guide to Who Pays First (Centers for Medicare & Medicaid
Services) - Large PDF file Medigap (Supplemental Insurance) Policies
(Centers for Medicare & Medicaid
Services) Prescriptions and Insurance Plans (American Academy
of Family Physicians) Also available in Spanish Uninsured: Access
to Medical Care (American College of Emergency Physicians) Your Guide
to the Appeals Process (Patient Advocate Foundation) Research
Use of Health Care Services by Lower-Income and Higher-Income Uninsured
Adults (American Heart Association) Return to top Journal Articles
References and abstracts from MEDLINE/PubMed (National Library of Medicine)
Article: Universal coverage and individual mandate in Switzerland:
lessons for Massachusetts. Article: Effects of a medication assistance
program with medication therapy management... Article: Prescription
for change. Health Insurance -- see more articles Return to top Dictionaries/Glossaries
Health Insurance Definitions (Bureau of the Census) Return to
top Directories State Health Insurance Counseling and Assistance Program
(SHIPs) (Centers for Medicare & Medicaid Services) Return to top
Organizations Centers for Medicare & Medicaid Services Dept. of
Labor Return to top Law and Policy COBRA Continuation of Coverage (Centers
for Medicare & Medicaid
Services) Employee\'s Guide to Health Benefits Under COBRA (Dept.
of Labor) - Large PDF file Also available in Spanish ERISA: What
Is It and How Does It Affect You (Patient Advocate Foundation) How
to File a Claim for Your Benefits (Dept. of Labor) Life Changes Require
Health Choices: Know Your Benefit Options (Dept. of Labor) Also
available in Spanish Mental Health Parity Act (Centers for Medicare & Medicaid
Services) Newborns\' and Mothers\' Health Protection Act (Centers
for Medicare & Medicaid Services) Pension and Health Care Coverage:
Questions and Answers for Dislocated Workers (Dept. of Labor)
Questions and Answers on the Health Insurance Portability and
Accountability Act (HIPAA) Nondiscrimination Requirements (Dept. of
Labor) Women\'s Health and Cancer Rights Act (Centers for Medicare & Medicaid
Services) Return to top Statistics City vs. City: When It Comes to
Health Insurance Costs, Geography Matters (Agency for Healthcare Research
and Quality) FASTATS: Health Insurance Coverage (Centers for
Disease Control and Prevention) Health Insurance Coverage: Early Release
of Estimates from the National Health Interview Survey, January – March
2006 (National Center for Health Statistics) - Large PDF file
Health Insurance Data (Bureau of the Census) Low Income Uninsured
Children by State [2003-2005] (Bureau of the Census) Percentage of
Persons of All Ages Who Failed to Obtain Needed Medical Care Due to
Cost at Some Time during the Past 12 Months: United States, 1997-2006
(National Center for Health Statistics) - Links to PDF Tax Subsidies
for Employer-Sponsored Health Insurance to Exceed $200 Billion This
Year (Agency for Healthcare Research and Quality) Uninsured Americans:
Newly Released Health Insurance Statistics (National Center for Health
Statistics) Uninsured Individuals and Their Access to Health Care (Henry
J. Kaiser Family Foundation) - Links to PDF Return to top Children
Children\'s Mental Health — Insurance
and Payment Issues (American Academy of Pediatrics) Insure Kids
Now: Find Your State (Dept. of Health and Human Services) - Directory
of low-cost or no-cost health insurance programs for children
by state Insure Kids Now: Questions and Answers (Dept. of Health and
Human Services) Also available in Spanish Low Cost Health Insurance
for Families & Children
(Centers for Medicare & Medicaid Services) Return to top Women
Frequently Asked Questions about Health Insurance and Women.
Health insurance From Wikipedia, the
free encyclopedia Jump to: navigation , search It has been suggested
that Health plan be merged into this article or section. ( Discuss
) This article or section is missing citations and/or footnotes . Using
inline citations helps guard against copyright violations and factual
inaccuracies. You may improve the article or discuss this issue on
its talk page . Help on using footnotes is available. This article
has been tagged since December 2006 . The examples and perspective
in this article or section may not represent a worldwide view of the
subject. Please improve this article or discuss the issue on the talk
page . Health insurance is a type of insurance whereby the insurer
pays the medical costs of the insured if the insured becomes sick due
to covered causes, or due to accidents. The insurer may be a private
organization or a government agency. Market-based health care systems
such as that in the United States rely primarily on private health
insurance. Contents 1 History and evolution 1.1 Inherent problems with
private insurance 1.1.1 Adverse Selection 1.1.2 Moral Hazard 1.2 Other
factors affecting insurance price 1.3 Common complaints of private
insurance 2 Health insurance in the United States 2.1 Medicare 2.2
Medicare Advantage 2.3 Medicaid 2.4 The shift to managed care in the
U.S. 3 Types of Medical plans in the United States 4 Common Medical
Insurance Terms [8] [9] 5 Health insurance in Canada 6 Health insurance
in Australia 7 References 8 See also [ edit ] History and evolution
The concept of health insurance was proposed in 1694 by Hugh the Elder
Chamberlen from the Peter Chamberlen family. In the late 19th century,
early health insurance was actually disability insurance, in the sense
that it covered only the cost of emergency care for injuries that could
lead to a disability [ citation needed ] . This payment model continued
until the start of the 20th century in some jurisdictions (like California),
where all laws regulating health insurance actually referred to disability
insurance. [1] Patients were expected to pay all other health care
costs out of their own pockets, under what is known as the fee-for-service
business model. During the middle to late 20th century, traditional
disability insurance evolved into modern health insurance programs.
Today, most comprehensive private health insurance programs cover the
cost of routine, preventive, and emergency health care procedures,
and also most prescription drugs, but this was not always the case
A Health insurance policy is an annually renewable contract between
an insurance company and an individual. With health insurance claims,
the individual policy-holder pays a deductible plus copayment (for
instance, a hospital stay might require the first $1000 of fees to
be paid by the policy-holder plus $100 per night stayed in hospital).
Usually there is a maximum out-of-pocket payment for any single year,
and there can be a lifetime maximum. Prescription drug plans are a
form of insurance offered through many employer benefit plans in the
U.S., where the patient pays a copayment and the prescription drug
insurance pays the rest. Some health care providers will agree to bill
the insurance company if patients are willing to sign an agreement
that they will be responsible for the amount that the insurance company
doesn\'t pay, as the insurance company pays according to \"reasonable\" or
\"customary\" charges, which may be less than the provider\'s
usual fee. The \"reasonable\" and \"customary\" charges
can vary. Health insurance companies also often have a network of providers
who agree to accept the reasonable and customary fee and waive the
remainder. It will generally cost the patient less to use an in-network
provider. [ edit ] Inherent problems with private insurance Any private
insurance system will face two inherent challenges: adverse selection
and ex-post moral hazard. [ edit ] Adverse Selection Insurance companies
use the term \" adverse selection \" to describe the tendency
for only those who will benefit from insurance to buy it. Specifically
when talking about health insurance, unhealthy people are more likely
to purchase health insurance because they anticipate large medical
bills. On the other side, people who consider themselves to be reasonably
healthy may decide that medical insurance is an unnecessary expense;
if they see the doctor once a year and it costs $250, that\'s much
better than making monthly insurance payments of $400 (example figures).
The fundamental concept of insurance is that it balances costs across
a large, random sample of individuals. For instance, an insurance company
has a pool of 1000 randomly selected subscribers, each paying $100/month.
One of them gets really sick while the others stay healthy, which means
that the insurance company can use the money paid by the healthy people
to treat the sick person. Adverse selection upsets this balance between
healthy and sick subscribers. It will leave an insurance company with
primarily sick subscribers and no way to balance out the cost of their
medical expenses with a large number of healthy subscribers. Because
of adverse selection, insurance companies use a patient\'s medical
history to screen out persons with pre-existing medical conditions.
Before buying health insurance, a person typically fills out a comprehensive
medical history form that asks whether the person smokes, how much
the person weighs, whether the person has been treated for any of a
long list of diseases and so on. In general, those who look like they
will be large financial burdens are denied coverage or charged high
premiums to compensate. On the other side, applicants can actually
get discounts if they do not smoke and are healthy. Starting in 1976,
some states started providing guaranteed-issuance risk pools, which
allow individuals who are medically-uninsurable through private health
insurance to be able to purchase a state-sponsored health insurance
plan, usually at higher cost. Minnesota was the first to offer such
a plan, there are now 34 states which do. Plans vary greatly from state
to state, both in the costs and benefits to consumers and to their
methods of funding and operating. They serve a very small portion of
the uninsurable market -- about 183,000 people in the USA [ citation
needed ] -- but in best cases do allow people with pre-existing conditions
such as cancer, diabetes, heart disease or other chronic illnesses
to be able to switch jobs or seek self-employment without fear of being
without health care benefits. Efforts to pass a national pool have
as yet been unsuccessful, but some federal tax dollars have been awarded
to states to innovate and improve their plans. [ edit ] Moral Hazard
Moral hazard describes the state of mind and change in behavior that
results from a person\'s knowledge that if something bad were to happen,
the out-of-pocket expenses would be mitigated by an insurance policy--in
this case, one which provides reduced prices for medical care. [ edit
] Other factors affecting insurance price Because of advances in medicine
and medical technology, medical treatment is more expensive, and people
in developed countries are living longer. The population of those countries
is aging, and a larger group of senior citizens requires more medical
care than a young healthier population. (A similar rise in costs is
evident in Social Security in the United States .) These factors cause
an increase in the price of health insurance. Some other factors that
cause an increase in health insurance prices are health related: insufficient
exercise ; unhealthy food choices ; a shortage of doctors in impoverished
or rural areas; excessive alcohol use, smoking , street drugs , obesity
, among some parts of the population; and the modern sedentary lifestyle
of the middle classes. In theory, people could lower health insurance
prices by doing the opposite of the above; that is, by exercising,
eating healthy food, avoiding addictive substances, etc. Healthier
lifestyles protect the body from some, although not all, diseases,
and with fewer diseases, the expenses borne by insurance companies
would likely drop. A program for addressing increasing premiums, dubbed
\" consumer driven health care ,\" encourages Americans to
buy high-deductible, lower-premium insurance plans in exchange for
tax benefits. [ edit ] Common complaints of private insurance This
section is missing citations and/or footnotes . Using inline citations
helps guard against copyright violations and factual inaccuracies.
You may improve the article or discuss this issue on its talk page
. Help on using footnotes is available. This article has been tagged
since June 2007 . Some common complaints about private health insurance
include: Insurance companies do not announce their health insurance
premiums more than a year in advance. [ citation needed ] This means
that, if one becomes ill, he or she may find that their premiums have
greatly increased (however, in many states these types of rate increases
are prohibited). If insurance companies try to charge different people
different amounts based on their own personal health, people may feel
they are unfairly treated. [ citation needed ] When a claim is made,
particularly for a sizable amount, insureds may feel as though the
insurance company is using paperwork and bureaucracy to attempt to
avoid payment of the claim or, at a minimum, greatly delay it. [ citation
needed ] Health insurance is often only widely available at a reasonable
cost through an employer-sponsored group plan. [ citation needed ]
In the United States , there are tax advantages to Employer-provided
health insurance, whereas individuals must pay tax on income used to
fund their own health insurance, although there are a minority of pre-tax
health plans currently extant. [ citation needed ] Experimental treatments
are generally not covered. [ citation needed ] This practice is especially
criticized by those who have already tried, and not benefited from,
all \"standard\" medical treatments for their condition.
[ citation needed ] The Health Maintenance Organization (HMO) type
of health insurance plan has been criticized for excessive cost-cutting
policies in its attempt to offer lower premiums to consumers. [ citation
needed ] As the health care recipient is not directly involved in payment
of health care services and products, they are less likely to scrutinize
or negotiate the costs of the health care received. [ citation needed
] The health care company has popular and unpopular ways of controlling
this market force. [ citation needed ] Some health care providers end
up with different sets of rates for the same procedure. One for people
with insurance and another for those without. [ citation needed ] Unlike
most publicly funded health insurance, many private insurance plans
do not provide coverage of dental health care, or only offer such coverage
with additional premiums and very low dollar-amount coverages. Insurance
Companies can influence the type or amount of treatment that the insured
receives by setting limits on the number of visits, types of treatment,
etc., it will cover. [ edit ] Health insurance in the United States
The neutrality of this article is disputed . Please see the discussion
on the talk page . Please do not remove this message until the dispute
is resolved. Main article: Health care in the United States According
to the latest United States Census Bureau figures, approximately 85%
of Americans have health insurance. Approximately 60% obtain health
insurance through their place of employment or as individuals, and
various government agencies provide health insurance to over 29% of
Americans. [2] In 2005, there were 41.2 million people in the U.S.
(14.2 percent of the population) who were without healthcare insurance
for at least part of that year.(ibid) For many people, however, this
does not boil down to a simple question of affordability. Part of this
population might include young and healthy individuals with low risk
of serious illness who don\'t believe that health insurance would be
cost-effective. In fact, approximately one-third of these 41.2 million
live in households with an income over $50,000, with half of these
having an income of over $75,000. [3] Additionally, one third of these
41.2 million are eligible for public health insurance programs but
have not signed up for them. [4] People living in the western and southern
United States are more likely to be uninsured. [2] [ edit ] Medicare
In the United States, government-funded Medicare programs help to insure
the elderly and end stage renal disease patients. Some health care
economists (Uwe Reinhardt of Princeton and Stuart Butler among others)
assert that (the third party payment feature) these programs have had
the unintended consequence of distorting the price of medical procedures.
As a result, the Health Care Financing Administration has set up a
list of procedures and corresponding prices under the Resource-Based
Relative Value Scale . Starting in 2006, Medicare Part D provides a
program for the elderly to buy insurance for the purchase of prescription
drugs. [ edit ] Medicare Advantage Medicare Advantage plans expand
the health care options for Medicare beneficiaries. The option for
Medicare Advantage plans is a result of the Balanced Budget Act of
1997 , with the intent to better control the rapid growth in Medicare
spending, as well as to provide Medicare beneficiaries more choices.
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Act No Fear Act Centers for Medicare & Medicaid Services, 7500
Security Boulevard Baltimore, MD 21244 www3Medical billing
software prices can vary widely depending on the size and scope of
your practice and the software package you choose. Medical billing
software is offered in many forms to the discerning customer. Innovations
in the technology of medical billing software have created a new
benchmark of digital accuracy. There are many packages offered, such
as software with equipment lease, software lease via the Internet,
or the software along with installation and training. When you are
evaluating the needs of your practice, consider the factors that
will affect the cost of your medical billing software such as the
number of users, the number of patients, amount of use, and amount
of data storage.
Many software packages will not fill all the
diverse needs of your practice, so make sure you identify
vendors who are familiar with health care management
solutions and who will work with your practice to sustain
your advantage in the business. When investigating
prices for medical billing software it is a good idea
to ask how and for what purpose the system was designed,
and the cost for all the data to be secure, backed-up
and protected on servers that are compliant with the
HIPAA (Health Insurance Portability and Accountability
Act of 1996). Also find out what the total price will
be including ongoing costs, like upgrades, maintenance
and training.
Other significant factors that will affect the
price of medical billing software are the price of
user licenses, and the costs involved with customization
to fit your medical practice. Check to see if you can
configure the software without assistance, and whether
a first time user can quickly learn the program. If
the answer is yes to these questions, you will save
a bundle on training your staff. Selected vendors will
allow you to create your own medical software quote
by asking a series of questions that will identify
your precise needs. Keep an eye out for companies who
provide free updates to ensure continued HIPAA compliance.
There are medical billing software options out
there that require a minimal provider investment, such
as the web-based solution that allows the medical billing
provider to manage and maintain all of your data and
hardware within a totally secure remote environment.
You could have all of the advantages of great medical
billing software, including exclusive access to patient
information, at sharply reduced costs. Some points
of sale to look out for are: no hardware or software
to buy, no need for installation, and no upgrade costs.
Carefully evaluate the needs of your medical practice
to see if this easy and popular option is right for
your practice.
Finding a comprehensive selection of medical
billing software prices can be a simple task if you
are certain from the outset of your medical practice
needs, and the size and flexibility of your budget.
Medical billing software does not have to be costly
to work efficiently. Once an expensive bundle of complicated
interfaces filled with cumbersome textual fragments,
today's electronic medical billing suites are reasonably
priced, straightforward and intuitive.
Kiplinger Names Insure.com
a 'Best Site' for Life Insurance
based Insure.com Inc.'s Web site has been named a "best site" for life insurance quotes by Kiplinger's Personal Finance magazine.
The citation came in a special report called "The Best List" that appears in the November 2006 issue.
"Insure.com asks all the right questions about factors that can affect life insurance premiums and provides quotes from 40 companies without alerting insurers," the magazine says in the article on where to find the best deals on life, health, auto, homeowners and long-term care insurance.
The magazine lauds the insurer for posting underwriting criteria for each policy, so consumers know what standards they have to meet to qualify for a particular rate.
Insure.com, founded in 1984 as Quotesmith Corp., owns and operates a consumer information service and insurance brokerage for self-directed insurance shoppers.
Visitors to the Web site can obtain free instant quotes from insurers and buy policies online or by phone from any company shown.
The site offers more than 2,000 articles on insurance and also provides free insurance decision-making tools.
We are thrilled to have earned this recognition from such a respected and influential source as Kiplinger's Personal Finance," said Robert Bland, chairman and CEO. "At Insure.com, we are dedicated to providing a fast, simplified and money-saving experience for today's insurance shoppers. The Kiplinger's story on best life insurance Web sites is appearing at a time when life insurance premiums have just fallen again to all-time lows, which is great news for people who are shopping for life insurance. At Insure.com, visitors are free to buy from any company shown and all of our life insurance quotes are backed by a $500 Lowest Price Guarantee." Affordable
health insurance - it seems, especially today, those words just don't
belong together in the same sentence. Health insurance monthly premiums have
become the biggest single expense in our lives - surpassing even mortgage payments.
In fact, if you have any permanent health problems, such as diabetes,
or have had cancer at one time in your family history, your monthly cost could
easily be more than the house and car payment combined. Shopping for affordable health insurance can certainly be an
eye-opener. If you have always had a health insurance benefit where you
work - especially a state or federal employee - and now have to buy your
own, you may not be able to afford the level of health insurance coverage
you have become used to.
Affordable health insurance, however, is definitely available -if you
know how and where to look.
When you are looking for affordable health insurance, you want the
lowest cost per year that will fit your budget, of course. But, even more
importantly, you want a company that has a good record for paying without
fighting with you on every detail. Just as there is a car for just about
any budget, there is also affordable health insurance. You may not be able
to afford a "Cadillac" policy - but then you probably don't need all the
frills anyway.
Shopping for health insurance on the internet is the easiest and best
way to find affordable health insurance. Here are five reasons why.
1. You don't need a local agent to help you submit the claims for
health insurance. The medical provider does it for you. You save money
because the health insurance company saves money by not paying the agent
commission. This could amount to an 8% to 12% savings to you.
2. All the top health insurance companies are at your fingertips on the
internet. Most local agents can only quote you from the few companies that
they represent. They may not offer you what is best for you financially or
health-wise but only what they happen to have available.
3. Health insurance companies have to be extremely competitive because
it is so quick and easy to compare them with their competitors on the
internet today. In the past you would have had to visit physically eight
to ten agents to do a similar comparison. Most folks just didn't have the
time or desire for that.
4. You can change your coverage, deductibles, and payment options with
just a few clicks rather than going through the paperwork delay with a
local agent (and then finding out he/she made a mistake - more delay).
5. Charging to a credit card means you aren't going to forget a payment
and be without insurance. Also, it gives you another 30 days before you
actually have to pay. Also, many companies today give an additional
discount for "auto-pay".
The key, however, to finding affordable health insurance is realizing
that the purpose of any health insurance is to protect you from a major
financial loss - not to protect you from spending small money on clinic
visits and sliver removal. These small expenses may be cumbersome but they
generally will not hurt you. It's the $100,000 heart operation that will
break you. That's the financial disaster health insurance was originally
designed to prevent.
Also, keep this in mind. Health insurance, as with any insurance, is a
gamble. You are gambling that you will draw out more than you pay in. Your
health insurance company is gambling they will pay out less. The odds are
in their favor for two reasons. They have all the facts for millions of
families to average out, so they know the risk in advance. Also, they get
to set the rules and the prices. The higher you set your deductible, the
more risk you take. This is not a bad thing at all. You will most likely
be the winner in the long run.
Yes, finding affordable health insurance
is much easier than most people think. Taking more of the risk with
higher deductibles, spending a little time on the internet comparing
eight to ten different companies, and deleting coverage that you will
not likely need (such as maternity for many folks) will make it very
possible to find your own affordable health insurance.
AGE
In the elderly there appears to be a 'leveling out' of the gender
difference for major depression, although the overall prevalence of
depressive symptoms appears to increase with age (see Figure 2.4).
Several studies sug¬gest a rising incidence of depression in younger
age groups, particularly in young men, which may be linked to the relative
rise in suicide rates in this age group when compared to the declining
rates in the gen¬eral population4. Major depression in childhood
is no longer considered rare, the point prevalence in children lying
in the range 0.5—2.5%5. Depression is notably more common in
adolescents than in younger children, having an average period prevalence
of around 3—4%6.
COMORBIDITY
Depression and anxiety usually occur together, both in community
and clinical samples. Approximately two-thirds of those with a lifetime
history of major depres¬sion have a lifetime history of another psychiatric
disorder, and an even higher proportion of those with anxiety have multiple
previous disorders. Some of the 'comorbidity' of anxiety and depression
is artifactual, due to the categorical approach to psychiatric diagnosis.
The use of a more 'dimensional' approach, in which the severity of
individual symptoms and signs is described — rather than the
current categorical approach, which involves counting symptoms — would
reduce this apparent comorbidity. Patients with significant coexist¬ing
depressive and anxiety symptoms have a poorer prognosis with greater
impairment, greater persistence of symptoms, increased use of health
service resources and an increased risk of suicidal behavior.
REFERENCES
1. Ormel J,Tiemens B. Depression in primary care. In Honig A, van
Praag HM, eds. Depression: Neurobiological, Psychopathological and
Therapeutic Advances. Chichester, UK: John Wiley, 1997
2. Patel V. Cultural factors and international epidemiology. Br
Med Bull2001 ;57:33-45
3. Angst J. Epidemiology of depression. In Honig A, van Praag
HM, eds. Depression: Neurobiological, Psychopathological and
Therapeutic Advances. Chichester, UK: John Wiley, 1997
4. Fombonne E.True trends in affective disorders. In: Cohen P,
Slomkoski C, Robins LN, eds. Historical and Geographical
Influences on Psychopathology. New Jersey: Laurence
Erlbaum, 1999:1 15-39
5. Harrington R. Epidemiology. In: Harrington R, ed. Depressive
Disorder in Childhood Adolescence. Chichester, UK: John
Wiley, 1993
6. Fombonne E.The epidemiology of child and adolescent
depression psychiatric disorders: recent developments and
issues. Epidemiol Psychiatric Soc 1998;7:161-6
©2002 CRC Press LLC
CHAPTER 3
Recognition of depression
INTRODUCTION
In primary care the recognition of depression is often less than
ideal. For example, 50% of people with major depression, identified
by independent screening in GP waiting rooms, are not recognized
as depressed by the doctor1. The recognition of depression is particularly
dif¬ficult in certain patient groups such as the physically ill.
depression in 'unrecognized' patients has little effect on overall
outcome.
There are a number of key interview skills and cues that have been
identified as crucial to the recognition of depression (see Figures
3.2 and 3.3).
POSSIBLE REASON FOR LACK OF RECOGNITION
There may be a number of possible reasons for a lack of recognition
of depression within primary care (see Figure 3.1). Generally these
can be summarized as fol¬lows:
• patients ignore depression in themselves;
• fear of the stigma of mental illness;
• worry about side effects of medication;
• misdiagnosis of somatic complaints;
• overlooking of depression in those known to
have a physical illness; and
• blaming depression on circumstances, regarding
it as 'understandable'.
Unfortunately those patients who go unrecognized and untreated may
have poorer short-term outcomes on measures of low mood, reduced energy
and irritability. However, recent research suggests that disclosure of
IS DEPRESSION MORE COMMON TODAY?
There is some evidence that the incidence of depression may have
increased in younger cohorts. A long-term follow-up study in Sweden
(the Lundby Study)2 found a marked increase in incidence rates in
the 1960s and 1970s, and a ten-fold increase in the incidence for men
aged 20—39
years, for the period of 1957—1972 com¬pared to 1947—1957,
although this may be due to a limited amount of data before the 1960s,
against which to make a valid comparison. Although there have been several
studies that indicate a recent rise in the inci¬dence and prevalence
of depression, this remains fairly controversial due to methodologic
problems in data collection, particularly the recall bias for remembering
symptoms from more recent years.
REFERENCES
1. Goldberg DP, Huxley P. Mental illness in the community.The
pathway to psychiatric care. London:Tavistock, 1980
2. Hagnell O, Lanke J, Rorsman B, Ojesjo L.Are we entering an
age of melancholy? Depressive illnesses in a prospective
epidemiological study over 25 years: the Lundby Study,
Sweden. Psychol Med 1982; 12:279-89
©2002 CRC Press LLC
CHAPTER 4
Descriptions of the depressive disorders
INTRODUCTION
The ICD-10 and DSM-IV have largely similar approaches to the classification
of the depressive disor¬ders (see Figures 2.1 and 2.2), with a depressive
episode (ICD-10) and a major depressive episode (DSM-IV) being the pivotal
form of depressive illness, about which other depressive disorders are
described. However, in pri¬mary care, many depressed patients present
with depres¬sive symptoms that do not fulfil the accepted diagnostic
criteria for major depression or depressive episode, because the depressive
syndrome is too mild, too short, too long or without social consequences.
By contrast patients in secondary care inpatient settings are rather
unrepresentative of the total sample of patients, psychia¬trists
being likely to see the most severely ill and those patients with
'comorbid' (coexisting) disorders.
The most recent classificatory schemes include a num¬ber of other
depressive disorders, in an attempt to describe important groups of patients,
who otherwise could not be allocated a diagnosis. For example, both the
DSM-IV classification and the ICD-10 system include dysthymia (a chronic
mild depressive disorder), and the ICD-10 also incorporates recurrent
brief depressive dis¬order (RBD) within the group of mood disorders.
UNIPOLAR AND BIPOLAR DEPRESSION
When a person develops an episode of mania they are conventionally
identified as suffering from bipolar disor¬der, but those patients
with depressive episodes only are diagnosed as having unipolar depression.
This differenti¬ation is useful from a clinical perspective, as differing
treatment approaches are required for these disorders (see Figure 4.1).
The person who is in a manic phase of the bipolar disorder will usually
require 'anti-manic' treat¬ment, and treatment of any future depressive
episodes
must be carefully undertaken, so as not to precipitate a further
manic episode.
Most patients experience multiple depressive episodes over their
lifetime, the episodes varying in length, sever¬ity and impairment,
and in the response to treatment. Approximately 15% of consultations
in general practice are due to 'recurrent unipolar depression'1.
Anxiety symptoms are a common feature in many people with depression
and may be so prominent that they 'mask' the underlying depressive
symptoms, which are found only after direct questioning.
MAJOR DEPRESSIVE EPISODE
The two key features of major depression are depressed mood and loss
of interest or pleasure.
The prevailing mood is one of persistent misery, which does not respond
to good news. This is often accompa¬nied by a lack of enthusiasm
for previously enjoyable activities or hobbies. Figure 2.2 shows the
DSM-IV diag¬nostic criteria for major depressive episode.
The lifetime prevalence rates for major depressive dis¬order have
been estimated to range between 12% and 17%. However, there is a wide
variation in the reported prevalence rates for major depression (see
Figure 4.2). Table 1 shows the lifetime prevalence rates found across
a variety of locations27. The lowest rates were 0.9% in Taiwan, and the
highest 24% in Oregon (USA). European rates are closer to those of Oregon,
e.g. 15.7% in Basel18,19, 16% in Zurich27 and 16.4% in Paris21. A key
factor in identifying rates of major depression is the sen¬sitivity
of the questionnaire instrument. The Composite International Diagnostic
Schedule (CIDI) is probably a more sensitive instrument than the
Diagnostic Interview Schedule (DIS), which generally produces lower
rates.
©2002 CRC Press LLC
Table 1 Lifetime prevalence rates of major depressive disorder. CIDI,
Composite International Diagnostic Schedule; DIS, Diagnostic Interview
Schedule; DSM-III-R, Diagnostic and Statistic Manual III revised; HDS
(DPA), Diagnostic and statistic Manual I revised; NCS, National Comorbidity
Survey; SADS-L, schedule for affective disorders and schizophrenia; SADS-RDC,
schedule for affective disorders and schizophrenia - research diagnostic
criteria. Adapted with permission from Angst J. The Prevalence of Depression
in Antidepressant Therapy at the Dawn of the Third Millennium. Briley
M, Montgomery S, eds. London: Dunitz, 1998:198
Location
Reference
Instrument
n
Male
Female
Male + Female
Taiwan (metropolis)
2
Taiwan (small township) 3
Hong Kong 4
Korea 5
Korea (rural) 6
Puerto Rico 7
Iceland 8
ECA, USA 9
New Haven, USA 9
Baltimore, USA 9
St Louis, USA 9
Durham, USA 9
Los Angeles, USA 9
Mainz,Germany 10
National Survey, USA 1 1
Edmonton, Canada 12
Munich, Germany 13
Boston, USA 14
Sardinia 15
Christchurch, New Zealand 16
St Louis, USA 17
Basel, Switzerland 18,19
Stirling County, Canada 20
Paris 21
NCS, USA 22,23
New Haven, USA 24
Oregon (T1) 25
Oregon (T2) 25
Iceland 26
DIS 5005 0.7 1.0+ 0.9
DIS 3004 0.9 2.5+ 1.7
DIS 7229 1.3 2.4 -
DIS 3134 2.4 4.1 3.3
DIS 2995 2.9 4.1 3.5
DIS 1513 3.5 5.5 4.6
DIS/DSM-III 862 2.9 7.8 5.3
DIS 5.2 10.2 4.9
DIS 5063 - - 5.9
DIS 3560 - - 3.0
DIS 3200 - - 4.5
DIS 4101 - - 3.5
DIS 3436 - - 5.6
SADS-L 80 - - 7.7
8.4
DIS 3258 5.9 1 1.4 8.6
DIS 483 - - 9.0
DIS 386 5.1 13.7 9.4
DSM-III-R
CIDI 552 11.6 14.8 13.3
DIS 1498 8.8 16.3 12.6
DIS 298 12.8 23.8 14.8
CIDI 470 11.0 19.5 15.7
HDS (DPA) 1003 16.0
DIS/CIDI 1787 10.7 22.4 16.4
CIDI 8098 F F 17.1
SADS-RDC 12.3 25.8 18.0
SADS-L 1508 11.6 24.8 18.5
15.2 31.6 24.0
DIS 862 2.0 7.8 _
DYSTHYMIA (DYSTHYMIC DISORDER)
Dysthymia was first introduced into the group of affective disorders
in the DSM-III classification in 1980. It over¬laps substantially
with major depression, the main differ¬entiation being that dysthymia
is a chronic depressive disorder with milder symptoms. The chronic features
of dysthymia fluctuate in severity, and most sufferers will develop supervening
comorbid major depressive episodes (sometimes termed 'double depression’).
See Figure 4.3 for a summary of the DSM-IV criteria.
Estimates of lifetime prevalence of dysthymia are prob¬ably unreliable.
A review by Angst28 revealed a lifetime prevalence ranging from 1.1%
to 20.6%. Accurate diag¬nosis is often difficult and the reliability
low, since it is
largely dependent on the accurate recall of symptoms spanning 2 years,
which may be many years in the patient's past. The female:male ratio
is approximately 2:1, and dysthymia appears more common in the elderly
than in younger people. In one study of a Finnish cohort of elderly subjects
the prevalence was 12%29.
RECURRENT BRIEF DEPRESSION
Community studies, predominantly of young adults, indicate that many
people receiving treatment for depression do not fulfil the diagnostic
criteria for major depression30. Some experience shorter episodes of
depression, i.e. lasting less than 2 weeks. For some the
©2002 CRC Press LLC
depressive episodes recur at least monthly, and are brief, but usually
severe, with significant social and occupa¬tional impairment and
sometimes associated with suicidal behavior. Figure 4.4 show the
'Zurich criteria' for recurrent brief depression (RBD). Broadly similar
descriptions are now included within ICD-10 and Appendix B of DSM-IV.
Although RBD appears to be common in the commu¬nity there has been
relatively little research into the epi¬demiology of the condition.
One-year prevalence rates vary between 4% and 8%28; 14.6% of the population
in the Zurich study had fulfilled criteria for RBD by the age of 35 years.
The WHO primary care study found a point prevalence of 5.2% for 'pure'
RBD, together with a rate of 4.8% for RBD associated with other depressive
disor¬ders31.
classifications, there is little epidemiologic support for its being
considered a separate depressive disorder. Depression occurring in
the darker seasons of autumn and winter has been dubbed 'winter blues'
and is believed by some to be due to the lack of sunlight, particularly
in the northern hemisphere. But there is little agreement on which
seasons have the peak incidences of depressed mood, as it can occur in
autumn, winter, spring and even late summer! The current criteria for
SAD state that there should be at least three episodes of mood disturbance
in three separate years, of which two or more years are con¬secutive.
As follow-up studies indicate that many patients with 'SAD' develop
significant non-seasonal depressive episodes, the criteria stipulate
that seasonal episodes should outnumber non-seasonal episodes by more
than 3:1.
MIXED ANXIETY AND DEPRESSIVE DISORDER
The ICD-10 includes a category of mixed anxiety and depressive disorder
(MADD), to be recorded when symptoms of both anxiety and depression
are present, but neither set of symptoms, considered separately,
is suf¬ficiently
severe to justify a diagnosis. The appendix of the DSM-IV contains a
broadly similar description, but nei¬ther ICD-10 nor DSM-IV have
specified criteria. The recent UK Office of Population Censuses and Surveys
(OPCS) Survey of Psychiatric Morbidity found a point prevalence for MADD
(using ICD-10 diagnostic crite¬ria) of 7.7%, compared to a point
prevalence of only 2.1%, for depressive episodes32, rates in women being
almost double those in men (9.9% versus 5.4%, respec¬tively). The
course and treatment outcome of MADD are largely unknown, but the
disorder is likely to be of particular relevance in primary care
settings.
SEASONAL AFFECTIVE DISORDER
Seasonal affective disorder (SAD) was described origi¬nally by Rosenthal
and colleagues in 198433, and can be diagnosed using either ICD-10 or
DSM-IV criteria. DSM-IV describes SAD as being a mood disorder with an
established seasonal pattern (see Figure 4.5). Seasonal variations in
mood are well established and have been commented on by numerous sources
ranging from Aretaeus and Hippocrates, to Shakespeare in The Winter's
Tale: "a sad tale's best for winter". Although the concept
of 'seasonal affective disorder' has gained a degree of recognition
in both the ICD-10 and DSM-IV
POSTPARTUM DEPRESSION
Approximately 29% of women after childbirth experi¬ence some mild
decline in mood and/or increased anxi¬ety, thought mainly to be due
to psychosocial changes associated with motherhood34. Most do not require
treatment. However, postpartum depression affects 14% of women. The features
generally fit the DSM-IV crite¬ria for major depression and the diagnosis
is given when the onset is within 4 weeks postpartum, as defined in the
'postpartum onset specifier'. Anxiety is often a prominent feature with
high levels of anxiety, particu¬larly obsessional ruminations about
the health of the infant.
BIPOLAR AFFECTIVE DISORDER (MANIC-DEPRESSIVE PSYCHOSIS)
Community surveys in industrialized countries esti¬mate a 1% lifetime
risk for bipolar disorder and a 5% risk for the bipolar spectrum35. In
1990, bipolar disor¬der was estimated to be the sixth leading cause
of worldwide disability in people between the ages of 15 and 44 years
(see Figure 4.6)36. The mean age of onset is 21 years, which is earlier
than for major depression. Both sexes are affected equally, although
women tend to have proportionately more depressive episodes. The
cyclical pattern of mania and depression was previously called 'manic-depressive
psychosis'. The current term of bipolar affective disorder or bipolar
illness is more appropriate, as many patients with marked disturbance
of affect do not ever experience psychotic phenomena, such as delusions
or hallucinations.
©2002 CRC Press LLC
Emotional highs or elation are normal responses to happy events or
good fortune. However, elation or 'mania', which seems to occur without
any obvious cause, or appears excessive or too prolonged, may be a symptom
or sign of several psychiatric syndromes, including manic episodes, acute
schizophrenic episodes and certain drug-induced states (see Figure 4.7).
Mania-like episodes can also occur as a result of some medical conditions
(e.g. hyperthyroidism), prescribed medication, nonprescribed psychoactive
substances (e.g. amphetamines, cocaine, caffeine) or antidepres-sant
treatments (antidepressant drugs, electroconvulsive therapy, light therapy).
Such manic-like episodes do not fulfil the diagnostic criteria for a
manic episode. Figure 4.8 shows the DSM-IV criteria for mania.
There are four key diagnostic categories in DSM-IV:
• bipolar I — at least one manic episode with or without
a depressive episode;
• bipolar II — one hypomanic episode and at least one
depressive episode;
• cyclothymia — long-term depressive and hypomanic
symptoms but no episodes of major depression,
hypomania or mania; and
• mixed episode — criteria are met for both a manic
episode and for major depression nearly every day for
at least a 1-week period.
People experiencing manic episodes often appear euphoric with abundant
energy and increased activity and decreased need for sleep, which
is usually accompa¬nied by an exaggerated sense of subjective well-being.
This is generally reflected in excessive talking (pressure of speech),
grandiose ideas and unrealistic plans. However, many also feel irritable
and exasperated, and the euphoric mood is sometimes tinged with sadness.
Judgement is typically impaired; this can lead to finan¬cial or sexual
indiscretions that may ruin personal and family life. Insight into the
changes in mood, activity and interpersonal relationships is usually
reduced. The mean duration of mania is 2—3 months.
Manic episodes rarely occur in isolation: more char¬acteristically,
episodes recur irregularly, becoming inter¬spersed with depressive
episodes, which may become relatively more frequent as time passes. Episodes
of ill¬ness tend to cluster at particular times in a patient's life,
for example when relationships are ending or when employment is changed.
DEPRESSION AND ANXIETY AFTER BEREAVEMENT
One of the main consequences of bereavement is psy¬chologic distress,
particularly sadness and depression. Other features include anxiety,
insomnia, somatic symp¬toms (somatization) and hallucinations. In
western cul¬ture, the expression of sadness following bereavement
is expected and its absence seen as pathologic. In addition to bereavement,
a sense of grief can be experienced from other major losses, such as
a terminal diagnosis, losing a job, a marriage that fails, amputation
or radical surgery. Figures 4.9 and 4.10 show typical physical and psycho¬logic
symptoms experienced during 'normal grief’.
Bereavement can also have a negative impact on health. There is an
increased risk of mortality particu¬larly within the first 6 months
after bereavement37^10. There is al
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