All About Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.

Let’s discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

A Prescription For the Health Care Crisis

With all the shouting going on about America’s health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it—people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they’ve encountered it, when people who’ve spent entire careers studying it (and I don’t mean politicians) aren’t sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he’d spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Though I’ve worked in the American health care system as a physician since 1992 and have seven year’s worth of experience as an administrative director of primary care, I don’t consider myself qualified to thoroughly evaluate the viability of most of the suggestions I’ve heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.

THE PROBLEM OF COST

No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we’ve spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we’ve been getting for each dollar we spend.

WHY HAS HEALTH CARE BECOME SO COSTLY?

This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can’t attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country’s GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).

Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.

Is it because of monstrous profits the health insurance companies are raking in? Probably not. It’s admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of $346.7 million, which, if projected out, predicts a yearly profit of around $1.3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it’s unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately $13 billion per year. Total health care expenditures in 2007 were $2.2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren’t likely different by any order of magnitude).

Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it’s hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was $2.2 billion, only 0.1% of $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year.

Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately $216 billion (see Table 2, page 4). Though this amounted to 10% of the $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.

Is it from administrative costs? In 1999, total administrative costs were estimated to be $294 billion, a full 25% of the $1.2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it’s hard to imagine it’s shrunk to any significant degree since then.

In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:

1. Technological innovation.

2. Overutilization of health care resources by both patients and health care providers themselves.

Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they’re treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don’t have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we’ve figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we’re great at doing in the United States is making technology available.

Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What’s not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies—but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn’t important—just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.

Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, “The Cost Conundrum,” Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.

A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:

1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven’t been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain “red flag” symptoms are present, most doctors would refer. If not, some would and some wouldn’t depending on their training and the intangible exercise of judgment.

2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.

3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.

4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).

5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they’re receiving a straight salary.

Gawande’s article implies there exists some level of utilization of health care resources that’s optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).

How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient—the “sweet spot”—in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn’t mean every physician knows it or provides them. Data clearly show many don’t. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.

In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.

But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next—

WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?

According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families—Implications for Reform, growth in health care spending “can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care.” When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you’d be spending 60% of your income on health care but that as a result you’d enjoy, say, a 30% chance of living to the age of 250, perhaps you’d judge that 60% a small price to pay.

This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn’t what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?

People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don’t realize that we’re already rationing at least some of it. It just doesn’t appear as if we are because we’re rationing it on a first-come-first-serve basis—leaving it at least partially up to chance rather than to policy, which we’re uncomfortable defining and enforcing. Thus we don’t realize the reason our 90 year-old father in Illinois can’t have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn’t). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we’re so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).

So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980′s (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn’t want to give up.

But how do we decide whether we’re getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn’t provide great clinical benefit—demented patients score higher on tests of cognitive ability while on it but probably aren’t significantly more functional or significantly better able to remember their children compared to when they’re not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.

Who’s best positioned to judge the value to society of the benefit of an innovation—that is, to decide if an innovation’s benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public’s views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone’s imagination).

THE PROBLEM OF ACCESS

A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance—emergency rooms—which has significantly impaired the ability of our nation’s ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors’ appointments, long wait times in doctors’ offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.

GUIDELINES FOR SOLUTIONS

As Freaknomics authors Steven Levitt and Stephen Dubner state, “If morality represents how people would like the world to work, then economics represents how it actually does work.” Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there’s always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.

Here then is a summary of what I consider the best recommendations I’ve come across to address the problems I’ve outlined above:

1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It’s harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn’t be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group’s higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory “open enrollment” period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that’s driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of “good” and “bad” insurance that’s currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a “public option” insurance plan open to all, I worry that if it’s significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another’s health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a “public option” remains comparable to private options, the very people it’s meant to help won’t be able to afford it.

2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn’t have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that’s true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let’s not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I’m not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.

3. Decrease overutilization of health care resources by doctors. I’m in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what’s truly best for their patients? The idea that external bodies—whether insurance companies or government panels—could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients’ welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient’s consideration, as long as they’re careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn’t). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients’ welfare, meaning doctors’ salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn’t seemed to promote shoddy care when doctors feel they’re being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.

4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:

* Making available the right resources for the right problems (so that patients aren’t going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the “sweet spot” with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we’ve been seeing for the last decade).

* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don’t actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it’s just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should—we’d just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).

* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can’t have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current “pre-pay for everything” model does.

Florida Health Insurance Rate Hikes and Quotes

Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

Community Needs Health Assessment

In 2012 the Internal Revenue Service mandated that all non-profit hospitals undertake a community health needs assessment (CHNA) that year and every three years thereafter. Further, these hospitals need to file a report every year thereafter detailing the progress that the community is making towards meeting the indicated needs. This type of assessment is a prime example of primary prevention strategy in population health management. Primary prevention strategies focus on preventing the occurrence of diseases or strengthen the resistance to diseases by focusing on environmental factors generally.

I believe that it is very fortunate that non-profit hospitals are carrying out this activity in their communities. By assessing the needs of the community and by working with community groups to improve the health of the community great strides can be made in improving public health, a key determinant of one’s overall health. As stated on the Institute for Healthcare Improvement’s Blue Shirt Blog (CHNAs and Beyond: Hospitals and Community Health Improvement), “There is growing recognition that the social determinants of health – where we live, work, and play, the food we eat, the opportunities we have to work and exercise and live in safety – drive health outcomes. Of course, there is a large role for health care to play in delivering health care services, but it is indisputable that the foundation of a healthy life lies within the community. To manage true population health – that is, the health of a community – hospitals and health systems must partner with a broad spectrum of stakeholders who share ownership for improving health in our communities.” I believe that these types of community involvement will become increasingly important as reimbursement is driven by value.

Historically, healthcare providers have managed the health of individuals and local health departments have managed the community environment to promote healthy lives. Now, with the IRS requirement, the work of the two are beginning to overlap. Added to the recent connection of the two are local coalitions and community organizations, such as religious organizations.

The community in which I live provides an excellent example of the new interconnections of various organizations to collectively improve the health of the community. In 2014 nine non-profits, including three hospitals, in Kent County, Michigan conducted a CHNA of the county to assess the strengths and weaknesses of health in the county and to assess the community’s perceptions of the pressing health needs. The assessment concluded that the key areas of focus for improving the health of the community are:

· Mental health issues

· Poor nutrition and obesity

· Substance abuse

· Violence and safety

At this time the Kent County Health Department has begun developing a strategic plan for the community to address these issues. A wide variety of community groups have begun meeting monthly to form this strategic plan. There are four work groups, one for each of the key areas of focus. I am involved in the Substance Abuse workgroup as a representative of one of my clients, Kent Intermediate School District. Other members include a substance abuse prevention coalition, a Federally qualified health center, a substance abuse treatment center and the local YMCA, among others. The local hospitals are involved in other workgroups. One of the treatment group representatives is a co-chair of our group. The health department wants to be sure that the strategic plan is community driven.

At the first meeting the health department leadership stated that the strategic plan must be community driven. This is so in order that the various agencies in the community will buy into the strategic plan and will work cooperatively to provide the most effective prevention and treatment services without overlap. The dollars spent on services will be more effective if the various agencies work to enhance each others’ work, to the extent possible.

At this time the Substance Abuse work group is examining relevant data from the 2014 CHNA survey and from other local resources. The epidemiologist at the health department is reviewing relevant data with the group so that any decisions about the goals of the strategic plan will be data driven. Using data to make decisions is one of the keystones of the group’s operating principles. All objectives in the strategic plan will be specific, measurable, achievable, realistic and time-bound (SMART).

Once the strategic plan is finished, the groups will continue with implementation of the plan, evaluating the outcomes of the implementation and adjusting the plan as needed in light of evaluation. As one can see, the workgroups of the CHNA are following the classic Plan-Do-Check-Act process. This process has been shown time and again in many settings-healthcare, business, manufacturing, et al-to produce excellent outcomes when properly followed.

As noted above I recommend that healthcare providers become involved with community groups to apply population level health management strategies to improve the overall health of the community. One good area of involvement is the Community Health Needs Assessment project being implemented through the local health department and non-profit hospitals.

Optimum Health Nutrition is the Pathway to a Healthy Life

Whether you are overweight or not, it is important to know about health nutrition. It is true that the problems resulting from overweight abound in the country and that these problems are connected in one way or other to nutritional deficiencies and improper diets. While obese people need to correct their diets, it is best even for those who are not overweight to follow the rules of optimum health nutrition to ensure that they are able to maintain the weight and remain healthy.

In this connection child health nutrition is also equally important. As they are in the growing phase, children need sufficient nutrition and it is also important that they understand the value of right nutrition early enough so that they will make it a habit all through their lives.

The primary rule of optimum health nutrition is that you should be aware of what you are eating. Sometimes the calories in what you eat may be high, sometimes your meal timings may be wrong, or sometimes there could be too much of harmful things like caffeine in what you take. This eating pattern has to be changed both in the case of adults and children, to manage the best possible child health nutrition. It may be a bit difficult in the beginning but will become a habit very soon.

The fundamentals of optimum health nutrition is having plenty of liquids in the diet, eating lots of fresh fruits and vegetables, and taking some dietary supplements to compensate for what could be lacking in the diet. The benefits of this balanced nutrition will be better immunity for the body, more energy, freedom from many common ailments, and an overall feeling of well being. Nutritional supplements are considered a part of this nutrition as well as child health nutrition because human body can often lack in minerals like iron or calcium and taking of supplements becomes mandatory to rectify the imbalance.

Consulting your personal doctor will help you to get some guidance on how to manage optimum health nutrition. He will be able to provide you with detailed information on the matter and will also give you tips and tricks to manage it on a day to day basis. Nutritionists and dietitians can also be helpful in giving advice on the matter. Once a person develops an interest in physical fitness, it is best for him to consult an expert in the field and get the necessary direction to move ahead fast in the chosen path.

The Impact Of Shift Work On Health

The health and motivation for shift work has been known to have its own peculiar demands. This has set it apart from jobs that have traditional hours of work. Shift work has its own health merits. The shift work has been created to aid workflow processes between employer, employee and tasks at hand. Over the years, it has been noticed that workers identified in shift work often receive better health plans, health products and remuneration and by this, give shift workers time to do other tasks or personal chores while being watchful of individual mental health.

However, the scientific and medical communities report continually that shift workers concerned stand an increased risk of certain health disorders and mental health challenges that have severe negative impact on the general well-being of work shift staff which may not be achieved until the right health products are used.

There is a concern for the 9 to 5ers, as one sees a case of the health of those who barely get by with the hard life of routine which most times is viewed to compensate only the boss at the top. Furthermore, we sought to consider those who work less conventional hours that include working shifts at night. Any way it is looked at, an adequate welfare plan should be in place for them while introducing supplements of health products.

Researchers have discovered that those more at risk of suffering certain mental health challenges and chronic ailments or diseases, are shift workers, such as flight attendants, police officers, doctors, bartenders, nurses, and the like. Shift work can be classified as any type of work schedule that involves hours that are uncommon, or unusual when comparing this type of work schedule with the traditional work schedule that occurs within the day between 6 am and 6 pm.

For clarity, the term shift work can refer to rotating shifts, working overnight, evening shifts and other flexible shift patterns desired or arranged by the employer that also addresses the challenge of mental health in shift work platforms. In other to assist shift workers, first aid boxes can be kept handy and filled with health products for shift workers.

It’s been recorded by the Bureau of Labor Statistics (BLS), that over 16.8% salary workers and full-time wage workers are employed to work alternative shifts. Another interesting discovery made is that evening shifts are the most common alternative shifts, which have their working hours starting at between 2 pm and midnight. Work schedules may also constantly change as a result of irregular work shifts that also result in mental health and hormonal imbalances.

In this article, we take a look at what the resultant effects of what shift work are, what shift workers can potentially do in other to lower their risks of diverse health problems and what salient reasons could possibly be behind these findings. The mental health and prescribed health products of shift workers should not be left unaddressed as this plays an important role in the health and total well-being of the workers.

At first glance, it appears as though shift workers have and work different hours compared to the regular workers’ typical 9-to-5 routine. Reports also show that this is not the only underlying factor, as one key factor also is an increased risk of some diseases.

Some medical associations such as the Medical News Today have reported on studies that relate lack of usage of health products and increased risk of certain health problems with shift work. These relationships have seen discoveries ranging from the predictable to the most amazing jaw-dropping situations.

A reputable medical journal published a meta-analysis in 2014 which suggested that shift workers face an increased risk of type 2 diabetes. This is a red flag. Taking into consideration, shift workers rotating shifts also face an increased risk of 42%. So we see a need for the inclusion of health products as ready supplements for shift workers.

Interestingly, shift workers who rotate night shifts for 15 years and above were found to potentially increase the health risk of lung cancer mortality and poor mental health. The use of health products will aid these situations enhance longevity and maintenance.

How to Plan Your Perfect Health Nutrition System

Most people are only vaguely aware of the need to be physically fit. If they want to put the idea into practice they should develop a personalized health nutrition system that they will be able to incorporate into their daily routine. Given below are some guidelines on how you can go about it.

The fist rule here is to fully analyze your current eating pattern. Note down consistently on a daily basis, at least for a week, all that you are eating. It is possible that you will be taken aback when you see that much of what you are eating every day are things that hardly provide you with any nutrition. On the contrary, many of it could be putting you in the red zone by stuffing you with unwanted calories by its fat content.

Once you get a clear picture of your food intake, you can set about designing your health nutrition system. It is possible that in the new plan you could be retaining many of the things that you have been eating all along.

For example, milk, eggs, bread, meat, vegetables, are all things that people consume on a daily basis whether they are concentrating on a balanced diet or not. All you have to do is increase certain foods and decrease certain other foods in the diet in a way as to make the diet perfectly suitable for your requirements.

A health nutrition system is a diet chart, or a meal plan that will contain all the nutrition that the body needs and it will also help you to resist the temptation to eat out or have junk food or gorge on chocolate every now and then. By regularly noting down what you eat, you will be able to keep track of the wrong foods that are a part of your diet. One way of avoiding them is to remove such foods, and even the ingredients necessary for cooking it, from the shopping list altogether.

Though getting started with a health nutrition system may be a little difficult, once you manage to get one in place, sticking to it is generally not much of a problem. If you find it difficult to choose one or to follow one the way you should, it is better to take guidance on the matter from professionals.

There are nutritionists and dietitians trained in the discipline who can advise you on the matter after understanding your level of physical fitness, and the areas where you need to improve. Their help will be good for starters.

Population Level Health Management and Predictive Analytics

There has been much discussion of population health management coupled with predictive analytics recently in the health care field. Why? Most who are discussing these topics see it as a means of improving the health of patients while reducing the costs of doing so. Providing better care at lower costs is becoming necessary as payers are beginning to pay for quality outcomes as they move away from fee-for-service.

What is population health and how does predictive analytics fit in? Let me begin by defining population health and illustrate predictive analytics. In statistics, population refers to the complete set of objects of interest to the investigation. For instance, it could be the temperature range of adolescents with measles. It could be the individuals in a rural town who are prediabetic. These two are of interest in healthcare. Population also applies to any other field of research. It could be the income level of adults in a county or the ethnic groups living in a village.

Typically, population health management refers to managing the health outcomes of individuals by looking at the collective group. For instance, at the clinical practice level, population health management would refer to effectively caring for all the patients of the practice. Most practices segregate the patients by diagnosis when using population health management tools, such as patients with hypertension. Practices typically focus on patients with high costs for care so that more effective case management can be provided to them. Better case management of a population typically leads to more satisfied patients and lower costs.

Population health from the perspective of a county health department (as illustrated in last month’s newsletter) refers to all the residents of a county. Most services of a health department are not provided to individuals. Rather, the health of residents of a county is improved by managing the environment in which they live. For instance, health departments track the incidence of flu in a county in order to alert providers and hospitals so that they are ready to provide the levels of care needed.

You should be able to see that the population whose health is being managed depends upon who is providing the service. Physician practices’ population is all the patients of the practice. For county health departments it is all residents of a county. For the CDC it is all residents of the United States.

Once the population is identified, the data to be collected is identified. In a clinical setting, a quality or data team is most likely the body that determines what data should be collected. Once data is collected, trends in care can be identified. For instance, a practice may find that the majority of the patients who are identified as being hypertensive are managing their condition well. The quality team decides that more can be done to improve the outcomes for those who do not have their blood pressure under control. Using the factors from the data that it has collected the team applies a statistical approach called predictive analytics to see if can find any factors that may be in common among those whose blood pressure is not well managed. For instance, they may find that these patients lack the money to buy their medication consistently and that they have trouble getting transportation to the clinic that provides their care service. Once these factors are identified, a case manager at the clinic can work to overcome these barriers.

I will finish this overview of population health management and predictive analytics with two examples of providers using the approach correctly. In August 2013 the Medical Group Management Association presented a webinar featuring the speakers Benjamin Cox, the director of Finance and Planning for Integrated Primary Care Organization at Oregon Health Sciences University, an organization with 10 primary care clinics and 61 physicians, and Dr. Scott Fields, the Vice Chair of Family Medicine at the same organization. The title of the webinar was “Improving Your Practice with Meaningful Clinical Data”. Two of the objectives of the webinar were to define the skill set of their Quality Data Team, including who the members were, and describing the process of building a set of quality indicators.

The clinics were already collecting a large variety of data to report to various groups. For instance, they were reporting data for “meaningful use” and to commercial payers as well as employee groups. They decided to take this data and more and organize it into scorecards that would be useful to individual physicians and to practice managers at each clinic. Some of the data collected was patient satisfaction data, hospital readmission data, and obesity data. Scorecards for physicians were designed to meet the needs and requests of the individual physicians as well as for the practice as a whole. For instance, a physician could ask to have a scorecard developed for him that identified individual patients whose diabetes indicators showed that the patient was outside of the control limits for his diabetes. Knowing this, a physician could devote more time to improving the quality of life of the patient.

Scorecards for the clinic indicated how well the physicians at the site were managing patients with chronic conditions as a whole. With predictive analytics the staff of the clinic could identify which processes and actions helped improve the health of the patients. Providing more active case management may have been demonstrated to be effective for those with multiple chronic conditions.

Mr. Cox and Dr. Fields also stated that the quality data team members were skilled at understanding access, structuring data in meaningful ways, at presenting data to clinicians effectively and in extracting data from a variety of sources. The core objectives of the data team were to balance the competing agendas of providing quality care, making sure that operations were efficient and that patient satisfaction was high.

A second example of population health management focuses on preventing cardiovascular disease in a rural county in Maine-Franklin County. Over a 40-year period, starting in the late 1960′s, a volunteer nonprofit group and a clinical group worked together to improve the cardiovascular health of the residents of the county. As the project advanced, a hospital joined in the efforts.

At the beginning of the prevention efforts, the cardiovascular health of this poor county was below the state average. As volunteers and clinical groups became more active in improving the health of its residents, various cardiovascular measures improved significantly and actually were better in some respects than more affluent counties in the state that had better access to quality health services. The improvements were driven by volunteers who went out into the community to get those identified as being at risk of developing cardiovascular problems involved in smoking cessation classes, in increasing their physical activity and in improving their diets. This led to lowering blood pressure, lowering cholesterol rates and improving endurance.

The results and details of this 40-year effort in Franklin County has been published in the Journal of the American Medical Association in January 2015. The article is “Community-wide CVD prevention programs linked with improved health outcomes”.

As you can see, a population level approach to healthcare provides effective results. A clinic can improve the outcomes of its patients with chronic diseases while balancing costs through improved efficiency by focusing on data at the population level. A community can improve the lives of its residents by taking a population level approach to preventive care. Population level approaches to healthcare are varied and can be very successful if population level theory is correctly implemented. Better results can be obtained pairing it with predictive analytics.

Get More Out Of Life With Herbalife Health Nutrition

Herbalife health nutrition is part of the range of products that the company offers. Some of the products categories in the range are:

Heart health
Women’s solutions
Men’s solutions
Children’s health
Core products for cellular nutrition
Healthy aging
Digestive health
Immune solutions
Stress management

With these specialized categories, you can be sure to get the nutritional balance best suited for your lifestyle, age group, gender or health problems that you might be experiencing. Nutrition is the most important aspect of health and not following the right nutritional plan could become the source of many other health problems.

A balanced diet could save your life

Health issues start with a balanced diet. Our bodies need a wide range of nutritional components to function properly. Herbalife health nutrition will ensure that you get all the vitamins, minerals and other substances that your body need to perform at it’s peek.

Some of the advantages from Herbalife nutrition are that it will keep your body in tip-top shape. This means that you will be able to not only perform at your best but also that you will be fully prepared for any health crises that may occur. Many common ailments occur due to a weakness in our bodies. An immune system that operates at 100% of its potential will prevent most illnesses to spread throughout the body and make us feel sick.

Prevention is better than cure

This is not only an old saying but a very true statement as well. Herbalife health nutrition can help to strengthen your immune system and in most cases, prevent you from falling ill. But if you do fall ill, the Herbalife nutrition range can speed up your recovery by ensuring that you get all the nutritional supplements that you need to get healthy and strong again.

The source of many ailments is not the ailment itself but a weakened immune system that is unable to effectively combat viruses or other infections. By strengthening your immune system through a healthy nutritional routine you will not only recover from ailments quicker but will also prevent most of them to get a foothold in the first place.

A specialist in health nutrition

The Herbalife health nutrition range recognizes that people and their nutritional needs vary greatly. They have therefore created a range of products that focus on individual needs. The different categories are easy to understand and you will have no problems in placing yourself in one or more of the categories. Every one of us has different needs and different lifestyles that require a specialist approach to nutrition. You can easily find the supplements suited to you by looking at the categories in which they are divided.

These categories have been designed to help you find nutrition solutions that will focus on you specifically. This will give you the peace of mind that you are getting the best possible nutritional help from the Herbalife health nutrition range of products.

Preventive Health Nutritional Supplements

The effectiveness of nutritional supplements in preventing certain diseases and disorders from developing is still being researched today, so any claims or miracle statements that guarantee the prevention of certain diseases is generally considered fraudulent. Certain vitamins, however, do contain antioxidants that protect the body from free radical damage, making them potent and therefore legitimate preventive health nutritional supplements.

1. Antioxidant preventive health nutritional supplements

Antioxidant preventive health nutritional supplements include vitamins C, E, and beta-carotene– a compound of vitamin A. Mineral antioxidants include zinc, selenium, and manganese. While it is likely improbable to rid the body from all free radicals, together, these vitamins and minerals help defend the body from oxidative stressors, working to increase the immune system.

2. How preventive health nutritional supplements work

Preventive health nutritional supplements can be packaged and sold as a sole-vitamin or mineral, or can be compounded together as complete multi-vitamins and minerals.

Each vitamin and mineral has its own function in fighting free radicals: vitamin C protects and aids the utilization of proteins in the body; vitamin E protects fat in cell membranes; beta-carotene protects against free radicals formed by ultraviolet light; zinc guards against free radicals that may have slipped by other antioxidants; and selenium enzymes guard the energy producing part of the cells.

3. Diseases and free radicals

A combination of antioxidant vitamins is important (taken in the right amount and dosage per day) because free radicals are known to be connected to an array of diseases such as cancer, heart disease, arthritis, cataracts, and even early aging, to name a few. It is speculated that a regular and complete intake of these preventive health nutritional supplements can greatly lower the chances of acquiring such diseases, as well as slow down the degenerative process.

The problem with preventive health nutritional supplements is that it is hard to know for sure if a certain disease would have occurred if a person was not taking the supplements in the first place, or the other way around. At this point, science cannot conclude that supplements are “cures” for many diseases. However, supplements have been proven to prevent deficiencies, such as scurvy. Preventive health nutritional supplements, therefore, should be seen as a health insurance for the body with no absolute guarantees.

Important reminder

Preventive health nutritional supplements are not regulated by the Food and Drug Administration Board, and therefore, it is safer to go with a manufacturer that is GMP-compliant to assure the ingredients and product claimed in the label contain the right amount and dosage. GMP compliance also assures that the product does not contain any contaminants.