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Oshawa Dentist: Everything You Need To Know About Wisdom Teeth Removal

For most people, the growth of wisdom teeth and its removal are usually considered rites of passage, much like the growth of a big child’s first permanent tooth. Not all preconceived notions of the wisdom tooth are true, however.

Wisdom teeth need to be removed. When your wisdom tooth appears, it is best to see an Oshawa dentist. You don’t go to the dental clinic expecting to have your wisdom tooth removed, however. Wisdom teeth are only removed in cases when:

*They are impacted and are not fully erupted

*They undermine the health of your gums

*They cause stress on your other teeth, leading to cavities

*They affect the way you bite and move your jaw.

In some cases, when the wisdom tooth is not affecting your bite, is fully erupted, and has proven to be harmless to your neighboring teeth, extraction is unnecessary. Your Oshawa dentist will assess the risks and benefits or wisdom tooth extraction and tell you if you should have your tooth removed or if it is fine just the way it is.

You can go to the dental clinic and have your tooth extracted right away. Usually, when you meet with your Oshawa dentist for your first consultation, you are not prepped for dental surgery or extraction right away. This is because your health and your teeth growth need to be assessed first. To make the actual extraction smooth, your dentist will ask you to have xrays performed on the site first. This way, s/he can see the growth pattern of your teeth. This will be the deciding factor of whether or not it is necessary to remove your wisdom tooth.

Wisdom tooth removal is awfully painful. The procedure itself is relatively pain free, so this notion, once again, is untrue. You will be given a local anesthetic so you won’t feel any pain as your Oshawa dentist does the procedure on your wisdom tooth. If you, like many adults, suffer from the fear of dental procedures, you can also request for a sedative. This will cost a little extra, but it can keep you very calm during your dental procedure.

You can expect your Oshawa dentist to close the operative/extraction would with sutures. The sutures will be removed on your next visit, usually leaving the gum open to dry.

Post-operative or post-extraction recovery is very painful. As is the case with any surgery or extraction, patients could expect to experience pain afterwards. This pain can last anything between a few days to a little more than a week. There are medicines to help manage the pain, however, and to counter any possible infections which could happen during recovery. Patients will be prescribed with pain medication and antibiotics, and will be allowed to recover in their homes. Taking the next two days off from work right after the procedure is advised as some bleeding in the gums may occur. The dentist can also prescribe a medicinal mouth wash to help clean the site, and during the recovery area, the patient will have to be on a soft diet.

All in all, though, as long as you have a capable dentist, wisdom tooth extraction is not a frightening event. If you are wondering if you need your wisdom tooth extracted, and for any other dental concerns, visit our clinic at 26 Gibbons St, Oshawa, ON L1J 4X7. You can also schedule an appointment by calling (905) 576-4537.

Your Smile Dental Care aims to help you achieve optimal oral health. If you need an Oshawa dentist who works in a relaxed and friendly environment, contact us today.

Enhance Your Body Mass with Danabol Ds at Affordable Price

Danabol is the most famous anabolic energy supplement used by athletes and bodybuilders around the world. It is also known as DBol, Blue Hearts, and Methandrostenolone, which was generated by medical professionals in sort to provide it to the athletes that they were competing against. At faster, it was published on the market and faster become the option energy supplements for athletes and bodybuilders of all aged individuals. Generally, it is an anabolic energy supplement with androgenic attributes, which is so valuable for adding both strength and muscle. This energy supplement significantly increases Glycogenolysis and protein synthesis by contributing the androgenic acceptors, performs quicker than any other energy supplement available on the market at these days. The hundred percent of Methandrostenolone is made particularly for injecting; nonetheless it is 17-aa energy supplement and can be taken orally.

16M4

In sort to generate this supplement, some chemical like Methandrostenolone has to be modified at the seventeenth carbon point, further more making it able to transfer via the liver. Had it not been modified this method, it is likely that the energy supplement would not have manufactured it via the liver and into the bloodstream and would include the huge amount of toxin to the liver. Even though this supplement has been modified, it is still toxic to the liver part. If taken in a huge number of doses so it is essential to follow suggested dosages for protection purposes. Based on this, let’s discuss more information about Danabol in detail.

Beneficial Impacts And Dosage Guidance Of Danabol

Based on this, it was promoted particularly fro bodybuilders and sportsmen to assist enhance their ability. Although medical professionals initialize suggesting it to users, because of its medical advantageous, it still remains most famous athletes majorly, because of its ability to assist enhance the lead body muscle. That is why several bodybuilders take this energy supplement, when they are seeking their carbohydrate bulk up and intake. Danabol DS are often used for the bulking cycle. It’s taken into consideration one of the best and quickest steroids in the marketplace as it has an existence, consequently dosing should take area each day.

Danabol DS users like using this steroid at the start of their Body Research as it gives them a jump start, in addition to after they hit a plateau to help them break via it. Danabol DS dosages may range from user to consumer. Customers can take anywhere from 10mg to benefit minimal effects all of the way as much as 100mg to get the most results. The cycles are four to 6 weeks long for this steroid. Although it is commonly regarded to be secure for users to take as plenty as 100mg safely, the maximum will find it sufficient to take 50mg as long as they may be purchasing the real Danabol DS blue hearts. There are corporations and websites that sell counterfeit variations of this steroid and they’re regularly either any other steroid disguised as this one or a decrease dosage of this one. No matter what some humans assume, AnabolTesto Caps are a bodybuilding complement, now not a real steroid.

Top 5 Plastic Surgery Procedures Done In the UK

P 3 marOver the years there has been a very significant increase in plastic surgery procedures being performed in the UK. According to the British Association of Aesthetic Plastic Surgeons, the top 5 surgical procedures for plastic surgery done in the UK are as follows:

Facial Plastic Surgeries

If you’re not satisfied with your facial appearance, plastic surgery can help you reconstruct your features in an attractive way. In UK facial plastic surgeries are divided into the following categories:

  • Face and neck lifts: these make the saggy skin or age wrinkles disappear and you look younger in years. If you want your face to match the age you feel, a face or neck lift might be the answer for you.
  • Face Contouring: if you want sharper cheekbones or more prominent chin, perhaps face contouring can help you.

Rhinoplasty

About 17% of the plastic surgery procedures in the UK are done on the nose. For those who want a slimmer, sharper nose a nose job is an ideal procedure as it can contour the nose to suit your face and enhance your appearance. Rhinoplasty augmentation is done for those who want to get fuller noses to suit their broader face structures.

Breast Surgery

For women who are satisfied with the shape of their breasts, plastic surgery provides them with a viable option to change the way they look. Here are the categories of plastic surgeries performed on the breast in the UK:

  • Breast reduction: this surgical procedure reduces the size of the breasts
  • Breast uplifting/tightening: for women who have saggy breasts, breast uplifting or tightening can help them get back the volume in their breast and make them perky like before.
  • Breast reconstruction: women who have lost their breasts as a result of mastectomy can opt for breast reconstruction surgery and have their breasts back. The surgical procedures performed in the UK involve the rebuilding of the breasts usually recreating the areola and the nipples as well.

Setting of the Ears

About 2% of the entire population of the UK considers they have prominent ears. There are cases where people want the shape and lie of their ears changed. Often people want to get a normal fold for their ears. The cases are varied in nature but the gist is that no matter what the shape of ears if they are a little out of place the person can be subjected to fun, criticism and loss of self confidence. Plastic surgeons in the UK offer comprehensive setting procedures for the ears through plastic surgery. Usually the ears are reconstructed from behind and only a little scar remains as a reminder of the surgery.

Body Image Changing

Plastic surgery for changing the body image can include abdominal reduction, liposuction, endoscopic plastic surgery, vaginal surgery, hair transplant and surgeries for scars and keloids. You can consult any practicing plastic surgeon to know and assess the risks and recovery options you have after you opt for a body image changing plastic surgery procedure.

Exam Tables with Stirrups – Allowing Patients to Stay Comfortable

Medical exam tables are an integral part of a doctor’s office or clinic or a hospital. If you visit any doctor’s office, then you must have definitely noticed it. The tables are covered with hygienic and stain-resistant vinyl and its derivatives that provide smooth and comfortable surfaces for the patients to sit or lean while being examined. There are different types of medical exam tables with stirrups that are suited to a particular use. Some of them are simple, flat slabs made up of wood or metal while others are complex and can be adjusted to accommodate the patients comfortably.

Modern exam tables have a padded and seamless cushion that is quite comfortable to recline. Their surfaces are resistant to stains or any type of dents and rips. These tables are disinfected and simply can be wiped dry. Some other features include adjustable headrest mounted on a steel frame with or without drawers, a paper roll holder and an articulated kneeler. Existing premium models are equipped with programmable configuration settings.

Bariatric exam tables

Bariatric exam tables are used for the examination of the patients suffering from obesity. These tables have become very popular over the last several decades. These can easily accommodate obese patients and are designed to safely hold 800 pounds and sometimes more. It is imperative for the equipment to be designed keeping in mind their physical incapability. These tables offer quick release and have hand-powered backrest controls with fully articulating footrest.

Radiolucent exam tables

Radiolucent exam tables are those medical treatment tables that are designed to be used during imaging procedures. These tables are devised from powder-coated metal and consist of lecrolite pad that helps in minimizing the static electricity. Some more common features of this table include IV pole and adjustable side rails. Some of the radiolucent tables are designed specifically for ultrasound procedures. The tables also consist of collapsible leg extension and when observed for pelvic imaging, it can be lowered for easier access with adjustable stirrups. This feature is best used for gynecological and urological examination.

Tilt Table

Tilt Table is another unusual and unique style of medical exam table that is also called hi-low tilt table. This table is designed in the way that it has variety of straps that can secure the patients on the table and prevent them to slide off when the table is tilted. The table has extreme range of motion and it can be tilted to the point that the patient becomes almost perpendicular to the floor. They are used when the patient have difficulty in bending down.

Medical exam tables with stirrups are essential equipment that offers several benefits to patients and their caretakers. This fully adjustable equipment with powered back is designed to help achieve a reliable examination of the patient. As, all the medical procedures are very stressful and frightening, so these modern exam tables whether manually adjustable or mechanized, have helped patients to be as comfortable as possible thus reducing stress and providing composure to the doctor as well as patient.

Recapture the wondrous smile that makes you sparkling and beautiful

As you age, things will start to deteriorate and fall apart. The nature of our mortality is one of the many unpleasant facts that each of us has to deal with. However, no one need grow old without a fight—that is a fight against the worst effects of it. It may be your desire to change certain things about the way you look. Perhaps you’re interested in changing the severe drooping that is taking place on various parts of your body. Perhaps it is also your desire to do something about missing or rotting teeth. The latter can be easily handled through dental implants in toronto.

If you are looking to recapture the wondrous smile of your youth, the one that everyone use to love and rave about, then you need not look far to do so. Dental professionals right here in Toronto can help you get back what you’ve lost. By inserting dental implants into your mouth your dentist will help you restore the healthy, sparkling state of your teeth. If your appearance lately has been displeasing to you, then you should take matters into your own hands and see your dentist about getting implants.

The implants can be done in a way that will appear perfectly natural. The implant will function just as the missing or replaced tooth did. You will not feel much of a difference and you will have no reason to fear long-term pain or discomfort. There are few reasons why you should not get dental implants if you have missing teeth. It can make you look a lot better. You will certainly feel better about yourself as a result of having this work done.

No one likes to grow old. However, there is nothing to be done about that. The best you can do is to make attempts to age with some grace and style. Getting high quality dental implants is a great way to attain that goal. Your dental implants will revive and refresh your sense of yourself. You will be able to re-cast your image amongst your friends and within other social circles. Indeed, having such implants done can change your life for the better professionally as well, as people will find you more pleasant to be around.

You should take great care in the dental clinic you choose to undergo such implants. The people you work with should meet the highest standards of professionalism. The dentist you work with should employ the latest and most advanced methods and technologies in the field. The entire process should be able to be done in as fast and painless a way as possible.

Getting dental implants is one of the many great things you can do to blunt the effects of aging. It is also a way that you can feel as though you are still a person who is energetic and desirable. These may seem like minor things, but when you start to add them up they can be a huge influence on your quality of life.

If you are looking for dental implants in toronto , then you need look no further. For more information please visit our website.

Identify the effective solution for your gum infection

Proper oral health care is the best way to avoid some infections in your teeth but unfortunately, many people have gum infection due to the cause of the improper intake habit and irregular oral maintenance.

Scaling and root planing solves your gum infection in the effective way:

Today most of the people are suffered from the gum diseases so that they need the effective remedy for their dental problem. If you have the gum disease, then you may acquire the scaling treatment. Before acquire such dental treatments you have to know what is scaling and root planing. Because in the procedure follows several steps and functions so that if you are understand the concept of the scaling approaches for your gum infections, then you may prepare yourself to adopt the scaling treatment for your dental infections.

  • Scaling and root planing is one of the effective ways top treat the dental problems and it is one of the non- surgical treatment methods and it is also called as the deep cleaning approach.
  • The main function of the dental treatment is to remove the tartar from your tooth surface.
  • Many people have feared to adopt the scaling methods for their gum infections but they are not realising the seriousness of gum infection.

If you have some fear to adopt the scaling techniques in your oral then you have to know the gum disease. It is one of the infections followed in the tooth and it destroys the tissue supporting teeth like alveolar bones and gums and so on. as a result you may get the severe pain in your teeth and you could not bear such pain as well as you may get the chance to lose your dental. So that adopting the scaling and root planing is the best way to avoid some bad results in your teeth.

Gum infections may attack your teeth slowly:

Scaling and root planing procedure supports you to control the gum infections so that you may utilise the support to maintain the health of your teeth. Generally in the gum infection may attack the human teeth in steps by step method. So if you are having some awareness about What is Scaling and root planingand the gum infections, then you can treat the gum infections early. Gingivitis is the first stage of the gum disease and if you want to identify such infection early, then you may find out such infections through eth symptoms that are,

  • Mouth sores,
  • bad breath
  • Shiny gums and so on

If you receive such things in your teeth, then you may immediately consult the dentist to cure your gum infections. If you are not taking any steps for the gingivitis, then your teeth may receive the next stage of the gum infections. Periodontitis may usually occur for the reasons of the improper treatment of gingivitis. Normally in such oral problem are occur die to the poor oral hygiene and such poor hygiene may form depends on the healthy issues of the man like uncontrolled diabetes. So that if you are following eth regular health check up then it may solve so many health as well as oral probalmes.

Schedule your appointment in online to remove wisdom teeth

It is very common that most of the people will have their wisdom teeth at their age of twenty. Four extra teeth will grow at the corners of teeth structure and while growing it will cause severe pain and discomfort. It will come from the jaws and when the shape is good the users can have a neat structure of teeth. Unfortunately, it will not grow in an aligned manner for most of the people and changes the shape of their jaw. So, the users who like to remove their wisdom teeth can visit this avatardentalcare.com/wisdom-teeth-removal/ platform to get proper guidance. In this platform, the users can find Guidelines for wisdom teeth removal and the citizens of Leesburg, VA can get the best treatment from the expert.

Uneasiness of wisdom teeth:

The individuals who are suffering from the chronic teeth pain and wisdom teeth pain can contact the above mentioned platform for receiving an exceptional service. An expert dental team from offers the wisdom tooth removal service to their users and helps them to prevent various dental issues. The Tooth Extraction will protect the gums and reduces the effects of decay and it is mandatory for the damaged tooth. The wisdom teeth removal service is essential when the tooth is growing through gums. It causes a severe pain and affects the nearby tooth also.

Procedure to remove wisdom tooth:

The users who like to remove their wisdom tooth needs to undergo a minor surgery. The surgery may take place at the hospitals or in the dental offices based on the severity of the condition. The wisdom tooth service may get delayed until the infection of the decay is cleaned up in the affected tooth. The procedure for the surgery is,

  • At first, a local anesthetic will be given to numb the wisdom tooth surface. It prevents the pain while operating it.
  • The sedation dentistry will be given to the users, who have the anxiety or fear about the dental procedures.
  • If one or more tooth is affected, then a general anesthetic will be used to remove the wisdom tooth using same procedure.
  • In these cases, the users can sleep throughout the surgery.
  • The gum tissue over the affected tooth will be opened and the covering bones will be removed by the experts. They will remove the bone from the tooth.
  • Finally, the stitches will be used to close the surgery wound.

It is a simple procedure to remove the wisdom tooth and it may take little longer to complete for getting complete cure. The painkillers will be suggested to the patients if they feel too much of pain. The experts will use the appropriate tools to operate the tooth however a minor pain will remain for few days. After the surgery the same issue will never rise and because the treatment is given based on the Guidelines for wisdom teeth removal service. So, the users are advised to schedule their appointment in online to remove their wisdom tooth.

Cheap Prices for Seeing Chiropractor

I have something that is wrong with my back and it is starting to bother me a lot. It seems to be getting worse and worse every day that goes past. I have no idea what the source of the pain was in the first place. I mean, I don’t remember having an accident or anything, but it does feel like one of my vertebrae is messed up. I want to see a chiropractor in Glendale to try to get my back feeling back to normal. I have never had back problems in my life up to this point in time, and so I am pretty concerned about this problem.

I had never realized how debilitating it could be to have a back problem. I was watching my daughter the other day, while my wife was at work, and I made her a grilled cheese for lunch. She has this problem where she does not like to sit down and eat at the table. Instead, she tends to wander around while she is eating, which is very frustrating. But anyway, she dropped some of the sandwich on the ground, and I went down to pick it up and throw it in the trash. But when I bent over, I ended up falling to the ground.

It made me feel weaker than I have ever felt in my life before. I am really concerned that this problem is going to get worse if it is not taken care of. I am just worried about what it could be. My aunt had a degenerative back condition a few years ago, before she died, and I know that it caused her all sorts of agony. I hope that I don’t have to go through anything like that, because I am not sure I could bear it.

Occupational Health – Workplace Health Management

Workplace Health Management (WHM) There are four key components of workplace health management:

  • Occupational Health and Safety
  • Workplace Health Promotion
  • Social and lifestyle determinants of health
  • Environmental Health Management

In the past policy was frequently driven solely by compliance with legislation. In the new approach to workplace health management, policy development is driven by both legislative requirements and by health targets set on a voluntary basis by the working community within each industry. In order to be effective Workplace Health Management needs to be based on knowledge, experience and practice accumulated in three disciplines: occupational health, workplace health promotion and environmental health. It is important to see WHM as a process not only for continuous improvement and health gain within the company, but also as framework for involvement between various agencies in the community. It offers a platform for co-operation between the local authorities and business leaders on community development through the improvement of public and environmental health.

The Healthy Workplace setting – a cornerstone of the Community Action Plan.

The Luxembourg Declaration of the European Union Network for Workplace Health Promotion defined WHP as the combined effort of employers, employees and society to improve the health and well-being of people at work

This can be achieved through a combination of:

  • Improving the work organization and the working environment
  • Promoting active participation of employees in health activities
  • Encouraging personal development

Workplace health promotion is seen in the EU network Luxembourg Declaration as a modern corporate strategy which aims at preventing ill-health at work and enhancing health promoting potential and well-being in the workforce. Documented benefits for workplace programs include decreased absenteeism, reduced cardiovascular risk, reduced health care claims, decreased staff turnover, decreased musculoskeletal injuries, increased productivity, increased organizational effectiveness and the potential of a return on investment (Mossinik, Licher1998 – Oxenburgh 1991).

However, many of these improvements require the sustained involvement of employees, employers and society in the activities required to make a difference. This is achieved through the empowerment of employees enabling them to make decisions about their own health. Occupational Health Advisors (OHA) are well placed to carry out needs assessment for health promotion initiatives with the working populations they serve, to prioritize these initiatives alongside other occupational health and safety initiatives which may be underway, and to coordinate the activities at the enterprise level to ensure that initiatives which are planned are delivered. In the past occupational health services have been involved in the assessment of fitness to work and in assessing levels of disability for insurance purposes for many years.

The concept of maintaining working ability, in the otherwise healthy working population, has been developed by some innovative occupational health services. In some cases these efforts have been developed in response to the growing challenge caused by the aging workforce and the ever-increasing cost of social security. OHA’s have often been at the forefront of these developments.

There is a need to develop further the focus of all occupational health services to include efforts to maintain work ability and to prevent non-occupational workplace preventable conditions by interventions at the workplace. This will require some occupational health services to become more pro-actively involved in workplace health promotion, without reducing the attention paid to preventing occupational accidents and diseases. OHA’s, with their close contact with employees, sometimes over many years, are in a good position to plan, deliver and evaluate health promotion and maintenance of work ability interventions at the workplace.

Health promotion at work has grown in importance over the last decade as employers and employees recognize the respective benefits. Working people spend about half of their non-sleeping day at work and this provides an ideal opportunity for employees to share and receive various health messages and for employers to create healthy working environments. The scope of health promotion depends upon the needs of each group.

Some of the most common health promotion activities are smoking reducing activities, healthy nutrition or physical exercise programs, prevention and abatement of drug and alcohol abuse.

However, health promotion may also be directed towards other social, cultural and environmental health determinants, if the people within the company consider that these factors are important for the improvement of their health, well-being and quality of life. In this case factors such as improving work organization, motivation, reducing stress and burnout, introducing flexible working hours, personal development plans and career enhancement may also help to contribute to overall health and well-being of the working community.

The Healthy Community setting In addition to occupational health and workplace health promotion there is also another important aspect to Workplace Health Management. It is related to the impact that each company may have on the surrounding ambient environment, and through pollutants or products or services provided to others, its impact on distant environments. Remember how far the effects of the Chernobyl Nuclear accident in 1986 affected whole neighbouring countries.

Although the environmental health impact of companies is controlled by different legislation to that which applies to Health and Safety at work, there is a strong relationship between safeguarding the working environment, improving work organization and working culture within the company, and its approach to environmental health management.

Many leading companies already combine occupational health and safety with environmental health management to optimally use the available human resources within the company and to avoid duplication of effort. Occupational health nurses can make a contribution towards environmental health management, particularly in those companies that do not employ environmental health specialists.

Article Source: http://EzineArticles.com/6447194

A Prescription For the Health Care Crisis

postWith 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.

CONCLUSION

Given the enormous complexity of the health care system, no single post could possibly address every problem that needs to be fixed. Significant issues not raised in this article include the challenges associated with rising drug costs, direct-to-consumer marketing of drugs, end-of-life care, sky-rocketing malpractice insurance costs, the lack of cost transparency that enables hospitals to paradoxically charge the uninsured more than the insured for the same care, extending health care insurance coverage to those who still don’t have it, improving administrative efficiency to reduce costs, the implementation of electronic medical records to reduce medical error, the financial burden of businesses being required to provide their employees with health insurance, and tort reform. All are profoundly interdependent, standing together like the proverbial house of cards. To attend to any one is to affect them all, which is why rushing through health care reform without careful contemplation risks unintended and potentially devastating consequences. Change does need to come, but if we don’t allow ourselves time to think through the problems clearly and cleverly and to implement solutions in a measured fashion, we risk bringing down that house of cards rather than cementing it.

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