Harm Reduction: Fill & Download for Free

Thanks for the A2A. I believe the tax revenue will go into the general ledger and as such, some of it will go to direct care initiatives. How those initatives are implemented will be the job of the provincial governments. The care of persons who have disabilities is currently implemented under the various provincial disability supports mechanisims.Addiction has been deemed to be a mental disorder and some basic living supports are provided to people. However addictions are poorly understood as being a symptom of an underlying mental health condition. The current paradigm of addiction as the “disease” falls far short of the mark in the various treatement modalities, which now align them under an umbrella of concurrent disorders.Where those revenues would be most useful is in raising the level of risk awareness in vulnerable populations. By fostering better understanding of those underlying factors of existing mental health conditions, so too will the continuim of care for those who compulsively misuse substances be improved,Stanton Peele writes extensively on this subject. If how these new revenues are to be allocated is of concern to you, I encourage you to take a look at his work and the work of others involved in Harm Reduction and other fields of mental health studies.The Stanton Peele Addiction WebsiteCanadian Harm Reduction NetworkDisclosure: I was the inaugural webmaster of the CHRN website in 1998 and I was an early promoter of harm reduction as health promotion. However these opinions are my own and may not reflect the opinions of those health professionals currently working in this field of study.

Tobacco addiction has many variables. Nicotine for example is altered by the MIAO added to combustible tobacco Not to mention the 7,000 odd chemicals added to it.If you are truly interested in beating the costs associated with smoking, consider vaping. Not only do you save a great deal of money each week (depending on how much you smoke) it is also a form of harm reduction and is 95-99% safer than continued smoking. You spare your health and give your wallet a huge break.Many beginners vaping kits (include refillable tanks, coils, and power mod) can run between 40-50 dollars, a 30ml bottle of e-liquid run around $15 and will last you approximately 1.5– 2 weeks. Depending again on how much you smoke. Compared to a carton of cigarettes which is $110-140 Canadian funds. If you bought a carton each week, that would be 480$ a month or more.Back when I smoked I did the roll your own way. But that still cost $90 for a tub, and one tub did me, 1.5 weeks. Still costly and damaging to health.Vaping is not only less harmful to your body, it offers the enjoyment factor smoking gave. You receive all the multiple sensory inputs, taste, smell, sight (clouds) and hand to mouth physical action. Most vapers have improved health, and wean down their nicotine levels. Nicotine without the MIAO's in combustible tobacco is not addictive. Otherwise nicotine replacement therapies, patch, gum, lozenges etc, would be addictive which they are notI hope this is helpful. I was a 2 pack a day smoker most of my life. 4 years ago I tried vaping and never looked back. It is far more enjoyable than smoking ever was. Plus the additional bonus of costing less, and preventing me from further damaging my body. My health is a great deal better.Search out INNCO - International Network of Nicotine Consumer Organisations - Home for a consumer vaping rights/education group in your country for further information about vaping as a form of harm reduction alternatives. The consumer group for your country can direct you to a vape shop, and help you with your journey to being #smokefree

Uwe Reinhardt’s important 2003 article in Health Affairs “It’s the Prices, Stupid,” concluded that the difference in healthcare costs between the US and other countries is simply because the prices are higher for healthcare goods and services in the United States. If that explanation sounds a bit weird and unsatisfying, he does go into the long explanation where he names the culprits. As an academic health economist, however, the long answers Reinhardt pens aren’t that much more revealing to the average reader looking for easy-to-talk-about answers.But I’m going to give you something that you can really understand. I’m going to add for comparison, two process diagrams for the healthcare claims adjudication process. The first one is how healthcare claims are resolved in the United States, the second one, is how they are resolved in Canada.So what is ‘claims processing’ and why is it important to the cost of US healthcare? Claims processing is the receipt and adjudication of a claim for a medical service filed by the insured member (that’s you and me) against a third-party insurer (that’s our insurance plan). Claims are accepted or rejected by a Payer (our insurance company) based on the member’s insurance policy. In the US, over 160 million people have their claims adjudicated by private Payers on behalf of millions of employers’ group plans or through individually-owned plans.The commercialization of health insurance creates an almost endless number of different contractual terms and conditions. Each different insurance company (about 4,000 different carriers) processes claims in its own unique way, usually with its own software system. Millions of claims are transacted daily in the US. Each claim can trigger hundreds of actions based on extensive rules and regulations. Insurance companies and clearinghouses designed to help manage claims process many trillions of these actions each year.This ponderous variability across multiple stakeholders (stakeholders are the insurance companies, the drug companies, the plan member/patients, the government, the hospitals, the clinics, the doctors, and other 3rd party providers) makes the US claims payment infrastructure the most complex, the most expensive, and the least efficient claims processing system anywhere in the world. It’s also the reason why the US consumes at least twice as much healthcare administration as any other comparable industrialized country.Fig 1. (below) depicts the Rube Goldberg-esque processing method we've developed in the United States to adjudicate healthcare claims. This image isn't meant entirely to be a lampoon of the system ― it's a true representation of the actual system we use. In fact, the illustration doesn't include nearly enough features; there are layers upon layers of processes and rules that sit below what is shown on top.Fig 1. US Healthcare Claims System InfrastructureNo matter how someone is insured, once they enter the Provider’s system their data must be accounted for somehow, and that’s all reflected in the claims process. Every claims processing software system on the market must attempt to accommodate every possible claims scenario. Most Providers (physicians, clinics, hospitals, etc,) need to be able to claim against each Payer, not just the ones in their ‘network.’ Many claims interact with different programs including Medicare, Medicaid, the VA, and the Affordable Care Act. In addition, different states have different rules and different public and private funding sources. The Payers within those programs all have different claims formats. Providers who send in claims on behalf of their insured patients, must format each claim differently depending on their contract with that Payer, the patient's insurance and the applicable state laws.Incredibly in the US, there is no universal, standard claims format. Some are still even paper-based. Payers struggle with providing the correct contracts to each Provider, and Providers struggle with each different claims format. Mistakes with the first claims submission in some systems are as common as 'clean claims.' Some unethical Payers deliberately make their claims process as difficult as possible, further complicating the process. A mistake at any level kicks the claim out and the process starts over again. Oftentimes, valid claims, once rejected, are not re-submitted for a variety of reasons. Days, weeks, and months may be added to the revenue cycle for Providers due to delayed payments (and unpaid debt has ballooned across every Provider sector since 2015). In many cases, up to 80% of premium costs are spent dealing with claims, not medical care. It's really the convolution of so many variables that makes claims processing in the US an administrative nightmare ― and very close to the chaos it appears to be.The medical billing process is a major driver of healthcare spending in the US. Technology has streamlined many other consumer/industrial sectors; everything from banking, to online purchasing, to media distribution, to ride sharing. But that’s not true for the healthcare claims process. The complexity of the process with its multiplicity of plans and contracts, medical codes, share of government and private funding, multiple accounts to draw from for the same claim, inconsistent deductibles and reimbursement levels, even within the same plan, make it impractical to apply algorithms. Algorithms are computations that deal with finite numbers of precisely defined successive states, eventually producing a final outcome. Algorithms have made consumer-facing companies like Amazon, Facebook, Snapchat, and Uber successful. But health insurance claims are more like snowflakes—no two are exactly the same, making algorithms that depend on ‘sameness’ difficult to adapt. No matter how many feedback loops you build into the process, there continue to be so many computational failures along the algorithmic flow that real humans must intervene every so often to resolve problems and move the claim forward. But human touches are expensive and time consuming — and so far, no application of even the most advanced technology has been able to arrest the continual need to hire more and more administrators.Now let’s look at the same claim adjudication flow for a healthcare system like Canada’s (represented by Fig 2), where every person is covered. Keep in mind that claims for exactly the same medical tests and procedures occur in Canada as the US. On their authority as accredited Providers, Canadian physicians make claims submitted electronically to the provincial health Payer. Adjudication between Provider and Payer happens much the same way as it does in the US. But that’s where the similarity ends because there’s only one plan and one Payer ― no redundant middlemen. In Canada, there's only need for one secure interface between Provider and Payer. To put it into American terms, Canadians are all members of the same plan with the same coverage. The single Payer represents the Insurer, who is dedicated to providing all services to every citizen on an equitable basis.To make a claim for a service provided to a patient, a doctor or his office staff simply enters the provincial tariff codes into a secure electronic database hosted by the Payer. For Providers, there is only one set of prices for each province based on a fee-for-service payment structure. These prices are maintained for years with an annual inflation factor added. For patients, there is nothing to do; no paperwork, no bills. Everyone receives the same comprehensive coverage through their provincial plan based on a system that covers all basic medical services. Because the provincial plan pays, no Canadian has ever been denied care or accumulated personal debt for a medical reason.One Canadian clinic administrator can take care of all of the billing for a group of 10 to 20 doctors along with performing additional office tasks. That's a far cry from the US where it takes 7 administrators to handle the paperwork burden for every 10 physicians. A comparison of hospitals is the best example. It takes about 8 billing clerks to enter billing data for a large ~900-bed Canadian hospital. Contrast that to Duke University where their 957-bed hospital requires the employment of 1,600 billing clerks and an additional unknown number of billing consultants.The administration function is made easier because there’s no such thing as pre-authorization on the front end and the adjudication process for claims is infinitely simpler. Depending on area of practice, 95-100% of claims are paid by the provincial Payer every 15 days. That’s the length of the revenue cycle in Canada — two weeks. The flow chart for the Canadian healthcare system looks like Fig. 2. It's clean, simple, and precise, with no need for any of the billion dollar technology features and onerous government regulations that must be applied to the same adjudication process in the US. And fraud? According to the FBI about $272 Billion worth of medical and billing fraud occurs each year in the US. By comparison, the Canadian system is so simple that fraud is unheard of.Fig. 2 Healthcare Claim Payment Infrastructure in Single Payer SystemThe Canadians have created a plan benefit design that is comprehensive and their laws have given provincial governments the regulatory teeth to make it work. They understand that the more players who are allowed to represent more variable and alterable plans, the more administrative problems it creates for Providers and patients alike. The more Payers and plans ― what we like to call ‘choice,’ in America ― the greater the reduction in cost-effectiveness. Although opponents of 'socialized medicine' typecast it as 'Americans under the thumb of Big Government,' it's impossible to conceive of a system that's more bureaucratic, wasteful and corrupt than what we have now.That bureaucracy means that here in the US, all stakeholders are continually hiring more low-level clerks and administrators to manage the choke-points. (Fig 3. below) In this scenario there is no need for more physicians who would only generate more paperwork ― best to curtail the care to lessen the admin burden, and raise prices to pay for the new hires. Healthcare stakeholders have placed higher value on a good revenue cycle strategy than the delivery of healthcare itself. The result? Higher healthcare premiums, higher co-pays, more high-deductible plans, a high rate of inflation that guarantees significantly higher insurance plan costs each year, and far less coverage than ever before. The other result that’s perversely and indefensibly higher is insurance company profitability along with the billions of dollars in performance bonuses ‘taken’ by CEOs who somehow believe they deserve them. It doesn't matter that the insurers have failed spectacularly in their mission to provide affordable and comprehensive plans to Americans. It only means that ‘whoever has the gold makes the rules.’Fig. 3 Growth in Physicians and Administrators US Healthcare System 1970-2017According to a Harvard study, we put up with $60 billion in overpayments (Americans being charged and paying more than they should have been billed) Annual care for the uninsured and under-insured generates $85 billion in uncompensated costs covered by us, the taxpayers. There are $272 billion in medical billing fraud each year. That means the American system 'absorbs' more in unrecoverable costs due to fraud each year than the entire Canadian healthcare system costs to run! (absorbs = recovered out of higher premiums we all pay) There are also $262 billion in medical claims that are denied, leaving patients to scramble to either get the denial decision reversed or find an alternate means of financing their care. Physicians give away $125 billion in free services for rejected claims each year. Uncompensated care provided by American hospitals is over $38 billion per year. All told, the ‘waste, fraud, and abuse’ measure has been accurately authenticated at around $1.1 trillion of our $3.6 trillion healthcare system.Attempts to reclaim these losses add untold billions in administrative costs, not to mention the millions of hours of unpaid time spent by patients’ families attempting to get the medical care they need. In fact, every pointless and unnecessary cost in the system is recovered on the backs of Americans ― you and me. That’s because insurers don’t endure the cost; they simply recoup losses by increasing premiums, raising deductibles and decreasing coverage.Through all of this, it's key to remember that the number of uninsured Canadians is zero, and the personal debt accumulated for insured medical care is zero. Because the provincial plan pays, no Canadian has ever been denied care. Canada can offer this to everyone because they've wrestled their costs to the ground. Canada and Scotland have the lowest hospital administration costs in the world. There is much to be said about the simplicity and practicality of viewing healthcare as a right, and not a commodity.If a picture is worth a thousand words, then the two comparative process diagrams I’ve illustrated surely provide an eloquent answer to our healthcare problems. But the gains found by eliminating the tortuous claims process only occurs by moving to a simpler system. It’s time to take a serious look at how other countries deliver healthcare for half of what we pay before the harm the current system inflicts upon the country becomes an unrecoverable condition.