Finally, Healthcare reform is a reality. Passed by the House with a 219-212 vote, the bill now goes to President Obama for signing. And to complete the package, a bill of negotiated changes to the newly passed legislation will go to the Senate for a vote. It took a lot to explain ( a 18-day stretch in which Obama traveled to four states and lobbied more than 60 wavering lawmakers in person or by phone to secure passage of the health reform bill) to all the American lawmakers that health is a right and not a derivative of how much one can pay the Health management organizations or Insurers.

Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums. The bill will allow senior citizens get more help paying for drugs in Medicare. People with health problems that left them uninsurable could now qualify for coverage through a federal program.

Republican critics said the $940 billion legislation was a heavy-handed intrusion in the healthcare sector that will drive up costs, increase the budget deficit and reduce patients’ choices.
 

 

Medical Apologies: Do right and do well

An often overlooked tool in health care providers’ struggle with the malpractice crisis is the medical apology.  Two thirds of the states provide some form of protection for the medical apology (i.e., a simple apology is not admissible in court as an admission of culpability), and settlements reached post-apology are almost invariably lower that they would be otherwise.  (In the current environment, articles on medical apologies are popping up everywhere … even in the NY Times business section.)

It is important to note that an effective apology policy does not stop with the simple apology — I’m sorry that this happened to you — but must include a commitment to conduct a root cause analysis, to communicate the results to the patient and/or patient’s family, to implement systems improvements based on the results of the root cause analysis, and to offer a specific apology once the analysis is complete, and an offer of monetary compensation if the provider or its systems were at fault. 

Often, following a bad outcome, a patient’s family member may wonder if he or she could have done something different to prevent the bad outcome, and the analysis can serve to put his or her mind at ease.  In addition, patients and family members often sue because they want to be sure that ‘nothing like this ever happens to anyone else.’  If a provider can demonstrate that a root cause analysis has been done and systems improvements made so that the same mistakes cannot be repeated, then that impetus for filing suit is removed.

For example, the University of Michigan health system reduced malpractice payouts by about 50% following implementation of its program.  Other examples of successful programs abound.  (And here’s another resource on medical apologies.)

       
Originally by-
David Harlow

About two out of five cancers can be prevented: “As we mark World Cancer Day, this episode focuses on cancer prevention. Each year, over 12 million people are diagnosed with cancer. Cancer kills more people than AIDS, malaria, and TB combined but the good news is that approximately two out of five cancers are potentially preventable.”

E-health and m-health applications hold vast promise to improve global health. As these projects develop, leaders need to be cognizant of the need for a well-trained workforce to lead their implementation. An ideal approach will include needs assessment as well as education and training opportunities for that workforce. Successful local examples can be expanded into larger networks whose scale can be leveraged to more rapidly and effectively disseminate them. Such an approach should also foster the establishment of academic partnerships and centers of excellence in education and research in developing countries for sustainable capacity building while still being responsive to local needs

Read the original article on Health Affairs.

Anand Grover was recently appointed by the UN Human Rights Council as Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Special Rapporteurs hold an honorary position as independent experts appointed by the Human Rights Council to examine and report on a country situation or a specific human rights theme. This interview with Mr. Grover was conducted by Alec Irwin, Co-Managing Editor of Health and Human Rights, at the XVII International AIDS Conference in Mexico City in August 2008.

Health and Human Rights: What aspects of your background do you feel have especially prepared you to take on the role of Special Rapporteur on the right to health?

Anand Grover: What is very important for me is to bring to the Special Rapporteur’s role the strengths I have from my work with communities of HIV-positive people and with other marginalized groups. I’ve done a lot of work in India around HIV, discrimination, access to treatment, and also the rights of marginalized groups like men who have sex with men, sex workers, and injection drug users. What the HIV movement has shown is that it’s community empowerment which changes the paradigm.

We need to pay more attention to the content of the right to health as it is experienced by communities. This right is not only an abstraction to be argued about by academics or clever lawyers. It’s a vital part, a living part of people who actually enforce it themselves. In that sense, it’s crucial to respond to people, not just to make your own decisions. I have experiences in my work where the community has corrected me and told me, “Anand, you’re wrong.” And they proved to be right in the final analysis. I’m proud to say that the community has the right to correct me, so I’m committed to continuing the exchange with affected communities on critical health issues.

HHR: Could you give an example of a situation in which the community challenged you and changed your views?

AG: One instance was recently, when we were working on an amendment to Indian law that included, for the first time, punishing clients of sex workers. As their legal advisor, I had accompanied the representatives of the sex workers to the Office of Women and Children, which was in charge of drafting the amending law. When I looked at the law that was being proposed I remarked, “They’re punishing the clients; why should we be worried about that?” I didn’t see a problem. I explained to the sex workers what the law was about. They replied: “Let us go back to the office and you translate the text to us in Hindi.” So we went back to my office and I translated the documents for them. The sex workers said, “Anand, you have to oppose this law on our behalf.” I asked why, and they said, “We won’t be able to have clients, and we’ll starve to death.” So, the community corrected me there. Our intellectual faculties are abstract. We come to our conclusions by intellectual discourse. We don’t have the experience of oppression and discrimination. The community has that experience. If we don’t marry our intellectual analysis with the community’s experience, we can’t make the right decisions.

HHR: In these early stages of your work as Special Rapporteur, what do you see as the main challenges and opportunities?

AG: Well, I think we have a strong foundation to build on. There is a recognized right, which is established in international law and is also understood by countries, though of course it’s interpreted differently. This shows the importance of dialogue that includes all points of view. I’m a great believer in dissent and opposition of ideas. I’m a leftist, and people often think that leftists don’t believe much in dialogue! But I’ve always been a part of the “New Left,” which encourages a very strong element of dissent, which believes that effective strategies and policies can only be formulated after rigorous discussion. And I think that’s what is required. There are different ways of looking at the right to health that are entirely legitimate. So we need an ongoing process of dialogue.

That’s on the conceptual level. The second issue, then, is how this is implemented concretely, at the local level. The large majority of countries recognize a right to health, whether this is formally written into their constitutions or otherwise. So how the right is implemented becomes critical. Courts have issued judgments — are they actually translated into practice? The classical model of implementation is top-down. Well, I think the community, again, plays a very important role in transparency, accountability and effective implementation of the right to health. That’s the lesson again from HIV, which I want to impress upon Member States and other constituencies. That’s also a process of dialogue, which has to include both human rights activists and people who don’t necessarily believe in the human rights framework.

HHR: Do you see opportunities to advance this dialogue on specific issues?

AG: Two areas where I want to concentrate initially are access to treatment and health systems, including the whole area of budgeting and finance in the health sector. There are very different views on questions like the proper role of insurance — for example, whether we should have community health insurance or social insurance. And whether the focus should be on state-funded, tax-based health systems or on a greater role for the private sector. All these models may be legitimate, and the practical realization may be different in different countries. But any solution has to be premised on the idea that everyone, without exception, is entitled to the right to health.

Again, I do think there are many fundamental issues countries have agreed upon. And then there are civil society and health activists, affected and infected, who get engaged in these issues and exert pressure, for example, for access to AIDS treatment. Already there is great mobilization in the community about these issues, so I want to take that further. This will help governments to realize the rights of their citizens. I firmly believe in dialogue between civil society and government, like we have a dialogue with our government [in India] is critical. The government now sees the value of the community organizing itself, lots of people organizing. Communities can make sure that the government and the different agencies are delivering, that they are accountable.

The community is the most effective tool that we have: an organic tool, not a tool in the abstract or purely instrumental sense, but a living, organic tool which can see to it that the right to health is actually delivered. You just have to compare the efficiencies of the Global Fund, in terms of actual delivery, to the traditional systems of financing, and you see a vast difference. This suggests how we have to shift the paradigm across the sectors, not only in HIV. And HIV activists are very clear that health systems must respond to the needs of all people who suffer disadvantage in health — whether it’s because of poverty, as Paul Farmer has discussed, or because of other forms of discrimination and marginalization, for example the discrimination that affects indigenous peoples or other ethnic minorities. Now we must deliver, and those communities must be part of the process of decision-making, implementation, monitoring, and accountability. That’s what HIV has shown as a living reality, and that’s what we want to translate into other areas of health.

HHR: Why might the mandate of the Special Rapporteur be especially important right now?

AG: The economic crisis shows the importance of systematic action to protect rights, including the right to health, especially for poor and marginalized groups. In the 1990s, we had economic liberalization, which usually meant only privatization. The poor were pushed into deeper poverty, while the rich became richer. In this context, it’s all the more important to insist that the right to health is universal. But this isn’t just a philosophical principle. It’s about budgeting. As I said, we can’t ignore budgeting anymore. And budgeting doesn’t mean that governments in low-income countries must pay for everything from their own resources. The right to the highest attainable standard of health, and the responsibility to protect the right, have to be seen in international terms. This means you look at international systems of financing. If a country’s resources aren’t adequate, then money has to come from abroad, also. That financing commitment has to be part of the international rights agenda.

HHR: How do you plan to build on the contributions of Paul Hunt during his tenure as Special Rapporteur?

AG: That’s an important question. Paul Hunt has done tremendous work, and I’m glad to say I’m in regular communication with him. I’ve got a lot to learn from him, not only about the procedures, which are but a tiny part of the work, but also because he laid down the basic foundations and the contours of the work of the Special Rapporteur. And he’s been prolific in his writings, which I don’t think I’ll ever be able to match. If I can produce even half the number of reports he has generated, I’ll be happy!

Specifically I will try to see that what Paul did in terms of country missions are followed up by me, so that the progress or lack of it can be monitored. This will reinforce what Paul has done. Also on issues like indicators, he has made a good beginning. We need to explore that further.

Building on Paul Hunt’s achievements requires learning from him, seeking advice from him. I don’t believe that any person is better than another person; you only become better by learning from others, with humility. So I want to build on that previous work not with my own native intelligence, but drawing on what I described earlier, the experience of the community and the marrying of that experience with a nuanced understanding of the right to health.

Copyright © 2009 Grover. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Almost everyday i run into these Seniors who (used to) laugh off the Social Media revolution, regarding it as a peripheral happenning. It was good for their child”s social life, but Business uses of Social media? They could not see ANY. I hope they see this video and learn a few things.