Healthcare Sector Management Blog

Celebrity MDs

2012-02-15T09:30:00.000-05:00

Right now, I know of a few celebrity MDs. (Will try and add a few more to the list later):

Sanjeev Gupta
Kevin Ho
Chopra

America has a health care paradox

2012-02-15T09:28:00.000-05:00

From the link: http://www.kevinmd.com/blog/2012/02/america-health-care-paradox.html

There is a real PARADOX in American healthcare.

On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical industry continuously brings forth life saving and disease altering medications. The medical device industry is incredibly innovative and entrepreneurial. The makers of diagnostic equipment such as CAT scans and hand held ultrasounds are equally productive.

But, on the other hand, there is a dysfunctional health care delivery system.

Our current delivery system focuses on acute medical problems where it is reasonably effective. But it works poorly for most chronic medical illnesses and it costs far too much. When the famous bank robber, Willie Sutton, was asked why he robbed banks he replied “that’s where the money is.” In healthcare the money is in chronic illnesses – diabetes with complications, cardiac diseases such as heart failure, cancer and neurologic diseases. These consume about 75-85% of all dollars spent on medical care. So we need to focus there.

These chronic illnesses are increasing in frequency at a very rapid rate. They are largely (although certainly not totally) preventable. Overeating a non-nutritious diet, lack of exercise, chronic stress, and 20% still smoking are the major predisposing causes of these chronic illnesses. Obesity is now a true epidemic with one-third of us overweight and one-third of us frankly obese. The result is high blood pressure, high cholesterol, elevated blood glucose and toxins that lead to diabetes, heart disease, stroke, chronic lung and kidney disease and cancer.

And once any of these chronic diseases develops, it usually persists for life (of course some cancers are curable but not so diabetes or heart failure). These are complex diseases to treat and expensive to treat – an expense that continues for the rest of the person’s life.

What is needed is aggressive preventive approaches and, for those with a chronic illness, a multi-disciplinary approach, one that has a committed physician coordinator. Providers (and I refer here mostly to primary care physicians), unfortunately, do not give really adequate preventive care in most cases. And they generally do not spend the time needed to coordinate the care of those with chronic illness – which is absolutely essential to assure good quality at a reasonable cost.

When a patient is sent for extra tests, imaging or specialists visits the costs go up exponentially and the quality does not rise with the costs. Indeed it often falls. But primary care physicians are in a non-sustainable business model with today’s reimbursement systems so they find they just do no have enough time for care coordination or more than the basics of preventive care.

So the paradox is that we have the providers, the science, the drugs, the diagnostics and devices that we need for patient care. But we have a new type of disease – complex, chronic illness, mostly preventable, for which we have not established good methods of prevention nor do we care for them adequately once the disease develops. And all of this is exacerbated by an insurance system that puts the incentives in the wrong places. The result is a sicker population, episodic care and expenses that are far greater than necessary.

The journey of TR Reid to various countries

2012-02-05T02:33:00.000-05:00

From the link: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/

Reid's first stop is the UNITED KINGDOM, where the government-run National Health Service (NHS) is funded through taxes. "Every single person who's born in the U.K. will use the NHS," says Whittington Hospital CEO David Sloman, "and none of them will be presented a bill at any point during that time."

Often dismissed in America as "socialized medicine," the NHS is now trying some free-market tactics like "pay-for-performance," where doctors are paid more if they get good results controlling chronic diseases like diabetes. And now patients can choose where they go for medical procedures, forcing hospitals to compete head to head.

While such initiatives have helped reduce waiting times for elective surgeries, Times of London health editor Nigel Hawkes thinks the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."

Reid reports next from JAPAN, which boasts the second largest economy and the best health statistics in the world. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Yet Japan spends about half as much on health care per capita as the United States.

One secret to Japan's success? By law, everyone must buy health insurance -- either through an employer or a community plan -- and, unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.

Reid's journey then takes him to GERMANY, the country that invented the concept of a national health care system. For its 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, a member of the

German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy." As they do in Japan, medical providers must charge standard prices. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.

In the 1990s, TAIWAN researched many health care systems before settling on one where the government collects the money and pays providers. But the delivery of health care is left to the market. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But the Taiwanese are spending too little to sustain their health care system, according to Princeton's Tsung-mei Cheng, who advised the Taiwanese government. "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers," she told FRONTLINE.

Reid's last stop is SWITZERLAND, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal ("the sickness"), which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. The Swiss example shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies.

Today, Swiss politicians from the right and left enthusiastically support universal health care. "Everybody has a right to health care," says Pascal Couchepin, the current president of Switzerland. "It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."

OECD Web book contents

2012-02-05T02:27:00.001-05:00

Table of contents

Access all indicators below via the web book.

Chapter 1. Health Status

Life expectancy at birth
Premature mortality
Mortality from heart disease and stroke
Mortality from cancer
Mortality from transport accidents
Suicide
Infant mortality
Infant health: Low birth weight
Perceived health status
Diabetes prevalence and incidence
Cancer incidence
AIDS incidence and HIV prevalence

Chapter 2. Non-medical Determinants of Health

Tobacco consumption among adults
Alcohol consumption among adults
Overweight and obesity among adults
Overweight and obesity among children

Chapter 3. Health Workforce

Employment in the health and social sectors
Medical doctors
Medical graduates
Remuneration of doctors (general practitioners and specialists)
Gynaecologists and obstetricians, and midwives
Psychiatrists
Nurses
Nursing graduates
Remuneration of nurses

Chapter 4. Health Care Activities

Consultations with doctors
Medical technologies
Hospital beds
Hospital discharges
Average length of stay in hospitals
Cardiac procedures (coronary angioplasty)
Hip and knee replacement
Treatment of renal failure (dialysis and kidney transplants)
Caesarean sections
Cataract surgeries
Pharmaceutical consumption

Chapter 5. Quality of Care

Care for chronic conditions
- Avoidable admissions: Respiratory diseases
- Avoidable admissions: Uncontrolled diabetes
Care for acute exacerbation of chronic conditions
- In-hospital mortality following acute myocardial infarction
- In-hospital mortality following stroke
Patient safety
- Obstetric trauma
- Procedural or postoperative complications
Care for mental disorders
- Unplanned hospital re-admissions for mental disorders
Cancer care
- Screening, survival and mortality for cervical cancer
- Screening, survival and mortality for breast cancer
- Survival and mortality for colorectal cancer
Care for communicable diseases
- Childhood vaccination programmes
- Influenza vaccination for older people

Chapter 6. Access to Care

Unmet health care needs
Coverage for health care
Burden of out-of-pocket health expenditure
Geographic distribution of doctors
Inequalities in doctor consultations
Inequalities in dentist consultations
Inequalities in cancer screening
Waiting times

Chapter 7. Health Expenditure and Financing

Health expenditure per capita
Health expenditure in relation to GDP
Health expenditure by function
Pharmaceutical expenditure
Financing of health care
Trade in health services (medical tourism)

Chapter 8. Long-term Care

Life expectancy and healthy life expectancy at age 65
Self-reported health and disability at age 65
Prevalence and economic burden of dementia
Recipients of long-term care
Informal carers
Long-term care workers
Long-term care beds in institutions and hospitals
Long-term care expenditure)

HEALTH AT A GLANCE 2011: OECD INDICATORS

2012-02-05T02:25:00.001-05:00

OECD Indicators are a great source of information for doing research and for general knowledge. You can find some info from the link: http://www.oecd.org/document/11/0,3746,en_2649_37407_16502667_1_1_1_37407,00.html

Graphs: US Health Stats compared to other countries

2012-02-05T02:21:00.000-05:00

From the link: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/graphs.html

VERY Useful readings about Healthcare Management

2012-02-05T02:10:00.000-05:00

From the link: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/links.html

+Health Care and the 2008 Election
+General Analysis of the Health Care Issue
+Health Care Foundations, Think Tanks and Interest Groups
+The International Perspective

Details:

Health Care and the 2008 Election

Hillary Clinton's "American Health Choices Plan"
Sen. Clinton supports an individual mandate requiring everyone to buy health insurance, either through their existing provider, from "the quality private insurance options that members of Congress receive," or from a public plan option similar to Medicare. Her plan doesn't include any mechanism for enforcing that mandate, although when pressed, Clinton has said she is open to a variety of methods, including garnishing employees' wages if they do not obtain health care. Read her entire plan (PDF file).

"Hillary Clinton Unveils a Promising Health Plan"
A Sept. 2007 analysis by The Economist of Sen. Clinton's health care reform proposal.

"Hillary and Health Care"
From the NPR program On Point, a one-hour radio discussion of Sen. Clinton's plan, featuring journalists and health policy advisers to the Obama and Clinton campaigns (Sept. 2007).

Barack Obama's "Plan for a Healthy America"
Sen. Obama wants to provide "quality, affordable and portable coverage for all," but his plan falls short of Clinton's universal coverage -- it wouldn't require everyone to have insurance, just all children. And as with Clinton's plan, his offers no enforcement mechanism. Read his entire plan (PDF file).

"Obama v. Clinton on 'Universality'"
Slate's Timothy Noah analyzes the differences between the two candidates and outlines his own thoughts on getting to universal coverage (Nov. 30, 2007).

"Clinton, Obama, Insurance"
Paul Krugman compares the health care plans of the two candidates in this Feb. 4, 2008, New York Times op-ed piece: "The big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn't."

John McCain's "Straight Talk on Health System Reform"
Sen. McCain focuses on marketplace competition, which he believes will contain the rapidly rising cost of health care as well as make health care more affordable. His plan would replace employer-provided health insurance with a tax credit for individuals and families to buy their health insurance from any provider. But his plan doesn't require anyone to get insurance, nor does it prevent insurance companies from denying coverage to those with pre-existing medical problems. To lower health care costs, McCain also supports improved information technology, more transparency about the quality and cost of care, and tort reform to "eliminate frivolous lawsuits" against doctors.

"Why McCain Has the Best Health Care Plan"
Fortune editor-at-large Shawn Tully compares McCain's proposal to create "a kind of national insurance market" to the Democrats' "Medicare-like federal superprogram." His conclusion: "Both have huge flaws, but on balance McCain's is better," because "it puts the consumer in charge" (March 11, 2008).

"John McCain's Health Proposals Are Bad News for Big Pharma"
The Economist examines measures that McCain endorsed in the Senate that "place him closer to the Democratic contenders on health policy than to any of his Republican rivals for the nomination" (March 2008).

"Voodoo Health Economics"
Paul Krugman's April 2008 New York Times op-ed piece lambasting McCain's free-market approach to delivering health care.

"Fixing It: Health Care Policy"
From a 10-part Slate series offering advice to the next president, Ezra Klein lays out a guide to the politics of health care. Among his suggestions: "Do it first, don't write a bill, and let someone else take the credit." Klein also blogs about health care and politics for the left-leaning American Prospect.

"Health Policy Reform in the 2008 Election Season"
The Commonwealth Fund -- an organization that supports independent research on health care issues and a funder of this FRONTLINE report -- offers a comparison of the candidates' proposals and opinion polls asking the public and health care experts what they think of the candidates' plans.

Health08.org
This Web site run by the Kaiser Family Foundation -- which awarded correspondent T.R. Reid a Kaiser Media Fellowship in support of his work on this report -- tracks the health care issue in the 2008 campaign. Features side-by-side summaries of the candidates' positions and video forums with the candidates. Kaiser also cosponsored, with Harvard and NPR, a poll of primary voters which found broad support for requiring health insurance, but opposition to fining or otherwise punishing those who don't get coverage.

General Analysis of the Health Care Issue

"Health Care and the Presidential Race: Arguing Over the Care"
The Economist offers a pithy December 2007 overview of the thorny issues, informed by what some polls are indicating.

"Scalpel Please"
The Economist reports from California on that state's recent failed legislation to provide universal health care coverage.

"The Health Care Crisis and What to Do About It"
A lucid and thought-provoking essay by Robin Wells and Paul Krugman in the March 2006 New York Review of Books.

"Real Issues: Health Care Costs"
A one-hour discussion from NPR's On Point on the escalating costs of health care and the ramifications (Feb. 2008).

"Rising Health Costs Cut into Wages"
A Washington Post article on another reason runaway health costs are becoming an economic and political issue: they're contributing to the problem of stagnating wages.

"Creative Destruction"
The New Republic's Jonathan Cohn uses former TNR editor Michael Kinsley treatment for Parkinson's disease as a starting point for dissecting "the best case against universal health care": that a system responsible for providing care for all might stifle innovative but expensive care. Cohn has also written a book about the problems with American health care; listen to an interview with him discussing that topic from the NPR program Fresh Air.

"Flashback: And Health Care For All"
For the release of Michael Moore's documentary Sicko, The Atlantic combed its archives for articles critical of health care in America. The pieces they unearthed range from a 1910 critique of medical education up to an analysis of European health care circa 1960.

"Dust-Up: Healthcare Reform"
In February 2007, the Los Angeles Times ran this five-part debate over California Gov. Arnold Schwarzenegger's universal health care plan between a member of the governor's staff and an opponent of the plan. The topics discussed include the role of insurance in health care reform and the problem of insuring illegal immigrants. In January 2008, a compromise bill crafted by Schwarzenegger and the speaker of the California Assembly was rejected by a state Senate committee.

"In Massachusetts, Universal Coverage Strains Care"
Unlike California, Massachusetts managed to pass universal health insurance. But more applicants than anticipated have signed up for coverage, overburdening the commonwealth's primary care physicians, reports Kevin Sack in the April 5, 2008, New York Times. And the AP reports that the Massachusetts program is costing more than expected, forcing lawmakers to consider a $1-per-pack hike to the state's cigarette tax.

Health Care Foundations, Think Tanks and Interest Groups

Cato Institute: Universal Health Care
The libertarian Cato Institute favors free-market health care reforms and is skeptical that other nations' health care programs are better than the United States'. Michael Tanner, Cato's director of health and welfare studies, argues that other countries' health care programs "demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice." And economist Glen Whitman takes issue with the World Health Organization's low ranking of the U.S. health care system.

America's Health Insurance Plans' "Plan to Cover the Uninsured"
Any attempt to fix U.S. health care will mean changes for the nation's health insurance companies, so it is not surprising that the industry's lobbying group has put forth its own reform proposal. The gist of their plan: States should create "Guarantee Access Plans" to cover the uninsured with the highest medical costs, and in return, private health insurers will guarantee coverage to all other applicants. Read the full proposal (PDF file) online, along with their take on why health care costs are rising.

The Henry J. Kaiser Family Foundation
The Kaiser Foundation -- which awarded correspondent T.R. Reid a Kaiser Media Fellowship in support of his work on this report -- provides free information on health care through a network of Web sites and partnerships with media organizations. It offers primers on various facets of the U.S. health care system, including Medicare, the rising cost of health care and the uninsured. Kaiser also runs statehealthfacts.org, which compiles health data for all 50 states, and publishes the free Daily Health Policy Report.

Commonwealth Fund
The Commonwealth Fund -- a funder of this FRONTLINE report -- is "a private foundation working toward a high performance health system." To that end, the group established a commission in 2005 to study U.S. health care reform. Read the commission's initial report and its National Scorecard on U.S. Health System Performance, on which the United States scored a 66 out of a possible 100. The fund's site also features an interactive Web feature exploring various options for fixing the U.S. health care system, and a state-by-state health care scorecard.

The Dartmouth Atlas of Health Care 2008
A project of the Dartmouth Institute for Health Policy and Clinical Practice, the atlas documents "glaring variations in how medical resources are distributed and used in the United States." The 2008 atlas and its executive summary are available for download (PDF files), but the highlight of the site is the set of interactive data tools that allows users to produce custom reports comparing states, or even individual hospitals.

Brookings Institution Engelberg Center for Health Care Reform
The Engelberg Center "serves as the 'hub' of all Brookings activity related to health policy." Its home page features a Candidate Issue Index, part of a joint project with ABC News comparing the health care plans of Hillary Clinton, Barack Obama and John McCain, and commentary from the think tank's scholars.

The International Perspective

Organisation for Economic Co-operation and Development (OECD)
The Paris-based OECD publishes international statistics on a variety of economic issues, including health policy. In Health at a Glance 2007, it collects data on a wide range of health care indicators from its 30 member nations. From that data the OECD also publishes reports on individual countries, including this précis on the United States (PDF file).

World Health Organization (WHO)
Part of the United Nations, the WHO is the group whose World Health Report ranked the U.S. health care system 37th in the world in 2000. The WHO has not revisited those rankings since then, but it maintains the WHOSIS online database of international health statistics and publishes an annual World Health Statistics Report.

NHS Choices
The rebranded homepage of the United Kingdom's National Health Service reflects the April 2008 launch of Patient Choice, a program that allows Britons to compare hospitals, choose which specialists they wish to see, and book appointments online. It's the latest attempt by the mostly socialized NHS to introduce some market competition into health care delivery. The NHS site also features a guide to common health problems and advice on healthy living.

I am currently doing a MBA course on Healthcare Management !

2012-02-05T01:59:00.001-05:00

I am presently doing an MBA course on Healthcare Policy and Management as part of my elective courses of my MBA program. I am glad that this blog is of relevance to my studies!

It is my firm belief that hard work does not go waste. When you work at something hard enough and long enough, it shall bear fruits some day!

Cheers!
Gerry Som.

Four Models of Healthcare as per T.R. Reid

2012-02-05T01:47:00.004-05:00

4 models of healthcare:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

Beveridge Model

Bismarck Model

National Health Insurance Model

Out of Pocket model

Details:
There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills.

But we don't have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:

Beveridge Model
Named after William Beveridge, the daring social reformer who designed Britain's National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world's purest example of total government control.

Bismarck Model
Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system -- the insurers are called "sickness funds" -- usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model -- Germany has about 240 different funds -- tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

National Health Insurance Model
This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.

Out of Pocket model
Only the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat's milk or child care or whatever else they may have to give. If they have nothing, they don't get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.

Can USA learn something from the REST of the world about how to more efficiently run a Healthcare System? YES !

2012-02-05T01:34:00.002-05:00

Check out the link: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

5 Capitalist democracies and how they do it: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

UK
Japan
Germany
Taiwan
Switzerland

Interviews: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/

How does it work for the doctors in these 5 countries?
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/doctors.html

What lessons can USA learn from other countries?
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/lessons.html

Does Universal coverage mean Socialized Medicine?
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/socialized.html

What about the "Cost of Drugs" issue?
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/drug.html

Questions & Answers with Mr. T.R. Reid, author:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/notebook.html

TR Ried in India for Ayurvedic treatment ---> A video:
http://www.pbs.org/frontlineworld/stories/india701/video/video_index.html

About Ayurveda:
http://www.pbs.org/frontlineworld/stories/india701/interviews/ayurveda101.html

4 models of healthcare:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

Medical Tourism @ Bumrungrad International

2012-02-04T22:41:00.000-05:00

ABC News: Medical Tourism. First US Liver Transplant India

2012-02-04T22:37:00.002-05:00

Healthcare Beyond Borders

2012-02-04T22:32:00.002-05:00

T. R. Reid Part. 3

2012-02-04T22:28:00.000-05:00

T. R. Reid Part. 2

2012-02-04T22:26:00.001-05:00

T. R. Reid Part. 1

2012-02-04T22:26:00.000-05:00

Suzanne Gordon interviews TR Reid part 2

2012-02-04T22:25:00.000-05:00

Suzanne Gordon Interviews TR Reid Part 1

2012-02-04T22:24:00.000-05:00

Britain defends its health care against U.S. criticisms

2012-02-04T22:18:00.000-05:00

Sick Around the World: Japan. PBS Frontline part 2 of 2

2012-02-04T22:17:00.000-05:00

Germany's Health Care: Quality Care for All

2012-02-04T22:07:00.000-05:00

Health Care: What Other Countries Do Better

2012-02-04T22:05:00.000-05:00

T.R. Reid talks about health care systems around the world

2012-02-04T21:52:00.001-05:00

Sick Around the World: Japan. PBS Frontline part 1 of 2

2012-02-04T21:50:00.000-05:00

FRONTLINE | Sick Around the World | Preview Germany | PBS

2012-02-04T21:49:00.001-05:00

FRONTLINE | "Sick Around the World" Coming April 15 | PBS

2012-02-04T21:49:00.000-05:00

http://www.healthcareadministration.com/ ---> A useful site for Healthcare Management Professionals

2012-02-04T21:47:00.001-05:00

Link: http://www.healthcareadministration.com/

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Wonderful lines from the movie "SICKO" by Michael Moore.

2012-02-04T21:43:00.000-05:00

From the link: http://www.imdb.com/title/tt0386032/quotes

You know, when we see a good idea from another country, we grab it. If they build a better car, we drive it. If they make a better wine, we drink it. So if they've come up with a better way to treat the sick, to teach their kids, to take care of their babies, to simply be good to each other, then what's our problem? Why can't we do that? They live in a world of 'we', not 'me'. We'll never fix anything until we get that one basic thing right. And powerful forces hope that we never do. And that we remain the only country in the western world without free, universal health care. You know, if we ever did remove the chokehold of medical bills, college loans, daycare, and everything else that makes us afraid to step out of line, well, watch out. Cause it will be a new day in America.

#Parody: Hook-a-Canuck.com ---> From SICKO movie of Michael Moore. :)))

2012-02-04T02:53:00.000-05:00

The Medical Cartel: Why are MD Salaries So High?

2012-01-27T01:03:00.000-05:00

From the link: http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high

Interesting post about why doctor salaries are high in USA.

Supply of nurses rises in Canada; 25 per cent growth in nurse practitioners

2012-01-27T00:47:00.001-05:00

From the link: http://ca.news.yahoo.com/supply-nurses-rises-canada-25-per-cent-growth-200409270.html

TORONTO - Nurse practitioners are steadily gaining ground in Canada, according to a snapshot of nursing that shows overall growth of the workforce.

An annual report released Thursday by the Canadian Institute for Health Information said there were 354,910 regulated nurses working in Canada in 2010, an increase of 8.8 per cent since 2006.

"Between 2009 and 2010, the nursing supply increased by two per cent, so if you look at the population, it increased by one per cent approximately, so we're seeing double the growth there," said Carol Brule, the institute's manager of health human resources.

The report on the supply of registered nurses, licensed practical nurses, nurse practitioners and registered psychiatric nurses is important for planning and policy decision-makers, she said.

Nurse practitioners have extra training that allows them to order certain diagnostic tests, perform some procedures and prescribe drugs and other therapies. Although their ranks are still small, the report shows they increased by 25 per cent in 2010, to 2,486.

Brule called it an "emerging profession" with a complementary role.
"They can work as part of health-care teams. They certainly have a very key role to play — they can support the work of physicians," Brule noted.

Canadian Nurses Association president Judith Shamian said it goes back to a simple message that there are about five million Canadians who don't have access to primary care — and nurse practitioners can provide that service.

She heralded the size of the increase in Ontario but said growth has been slower in other provinces.
"So the 25 per cent — hallelujah! Do we need to keep up the 25 per cent? We need to keep it up until all Canadians have proper access, and not just access, but timely access."

She also welcomed the overall growth in the nursing supply, but indicated nothing is simple in analysis of the statistics.

A report from her association a couple of years ago projected a growing shortage of nurses, yet the situation is confusing because there are nurses who say they cannot find full-time jobs.
"So it's kind of a mixed bag of things," Shamian said from Ottawa. "You will find in most organizations a fair amount of vacancies, but they might not be desired positions."

Shamian said she often hears that new graduates are working in multiple clinical areas or at more than one institution to pay their bills — making it more difficult to gain expertise in a specific discipline.
"You cannot become an expert if one day you work in maternity, the other day you work in the long-term care, and then you are in emergency room," she said, referencing the phrase "jack of all trades, master of none."

"So it's not the way to build an important workforce and a professional workforce. So yes, we have a lot more work to do in this area."
She said that in some provinces, it's difficult to recruit home care nurses because the salaries are often lower than in acute care.

"The number of registered nurses working in long-term care went down which is not good, because the people who go into long-term care facilities are sicker and sicker," she noted.
"But it's not clear to me if the numbers went down because there are vacancies or because long-term care facilities are replacing registered nurses with practical nurses, which are a cheaper workforce.
"And if that's the case, then it's a policy problem."

In terms of mobility, Brule said the "magnet provinces" of British Columbia, Alberta and Ontario were the top three destinations for work for Canadian-educated nurses who left their jurisdiction of graduation.

The age for nurses entering the workforce is often 30 or older, she said, and the 40-to-59 age group dominates the profession.

A breakdown shows that three-quarters of regulated nurses were RNs in 2010, while 23 per cent were licensed practical nurses and 1.5 per cent were registered psychiatric nurses. Those proportions have remained steady for the last five years.

There were 787 registered nurses per 100,000 population in Canada in 2010, the report said. In the early 1990s, there were 824 RNs per 100,000 population — a ratio that has not been achieved since that time.

Shamian said she's concerned that the number of managers has been going down every year.
"A manager — we have research — should be providing leadership to anywhere between 40 to 50 individuals, and if you don't have managers, then they cannot nurture and help the new graduates," she said.

Supply of doctors at an all time high and a glut may be on the horizon

2012-01-27T00:44:00.001-05:00

From the link: http://ca.news.yahoo.com/supply-doctors-time-high-glut-may-horizon-200354011.html

Now they say that there is an excerss of doctors !!! Can you believe this ?!!!

TORONTO - The doctor shortage of a few years ago is being resolved and Canada could be heading towards a glut of physicians, data in a new report on the supply of doctors suggest.

The number of practising doctors in Canada is at an all-time high, with nearly 70,000 active physicians working in the country last year. Out-migration of doctors has declined, licensing of international medical graduates has increased and medical schools are pumping out record numbers of new doctors, said the report by the Canadian Institute for Health Information.

"I think the actual story here is — boy, this was all so predictable and guess what? It's all coming to pass," said Dr. Morris Barer, a health policy analyst with the University of British Columbia's Centre for Health Services and Policy.

"The die has been cast, our future has been set in stone, and now we watch. And I think the people who should be really worried are the funders and policy makers across the country — because the cost pressures are going to increase dramatically."

Barer doesn't think Canada currently has a glut, but he's not sure the country had a shortage a few years ago either. He said there is no magic formula for figuring out what the right number of doctors is for a country.

"Too many factors need to be taken into account in thinking about that and I don't think that there's any science that could ever determine that for you," he said.

"It's partly a function of what you're willing to pay for and what sorts of other personnel you're prepared to train to provide certain parts of health care."

But more doctors probably means the push to rationalize the delivery of care by devolving some tasks to other health-care personnel — nurse practitioners or physician assistants — may suffer, Barer suggested.

Health economist Arthur Sweetman doesn't believe Canada has a glut of doctors yet either, but suggests it might be headed that way, with large medical school intakes still underway.

The problem isn't just about how many doctors the country has, but where they are practising and what their specialty is, he said, suggesting the country may be training too many pediatricians and too few gerontologists, ophthalmologists and orthopedic surgeons to cope when baby boomers become senior citizens.

"We have the short-term glasses on right now. We need to maybe put the long-term glasses on," said Sweetman, a member of CHEPA — the Centre for Health Economics and Policy Analysis — at McMaster University in Hamilton.

"Are are we still going to need the really high numbers that we're allowing into medical school now in eight or 10 years?" he questioned. "We need to be planning a decade ahead, because it takes a decade to train a physician."

Health economists have warned that in a system that is still largely based on paying doctors a fee for every service they do, an oversupply of doctors could see more doctors doing more tests and procedures on a smaller number of patients each in order to ensure they earn a decent living.

The report on the supply of doctors was released in tandem with one that delves into what provinces and territories pay doctors.

Trying to arrive at a representative figure is complicated because the health statistics agency doesn't get enough data to report on one stream that makes up about 25 per cent of the payments from provinces and territories to doctors, said Yvonne Rosehart, program lead for the physician team in CIHI's health human resources unit.

CIHI calls that stream "alternative" payments, referring to monies paid to doctors who are on salaries in family practices, who get bonuses to work in rural areas where the fee-for-service model doesn't really work, or who get other types of bonuses.

The remaining 75 per cent of payments to doctors covers fee-for-service billings.
Some doctors would make most of their income through the fee-for-service, but others would receive payments through a mixture of the two. For instance, some physicians may work the occasional hospital shift in addition to their private practice, earning a salary per shift for the one and fee-for service payments for the other, Sweetman said.

Looking at only the fee-for-service numbers, the agency estimates that on average family doctors earned a gross income of $239,000 last year and specialists earned a gross of $341,000.

Those figures would not be a doctor's actual income — a doctor who ran his or her own office would have to cover the office overhead out of those gross figures, Rosehart said.

The report said doctors' salaries increased by 7.4 per cent in 2010, down slightly from the 9.7 per cent and 8.8 per cent increases of the previous two years.

In terms of numbers, there were 203 physicians for every 100,000 Canadians in 2010, up 35 per cent from the rate in 1980. The number of doctors per 100,000 Canadians rose in all provinces and territories — except Yukon and Northwest Territories — over the past five years.

What are the Non-Medical Careers For Doctors?. What can MBBS doctors do apart from Medicine?

2012-01-10T12:15:00.000-05:00

Will complete soon...

For now, let me quickly type a few:

Sales
Marketing
Administration
Medical Insurance Claims processing
Allied fields
Clinical Research
Business Management
Consulting
Will complete soon.

Executive compensation at Ornge, Canada

2012-01-04T16:22:00.001-05:00

Ontarians can find out that the chief operating officer made $282,000 in 2010. But they can’t find out what Dr. Chris Mazza, the president and chief executive officer, makes. Why? Because ORNGE has broken up its business into a not-for-profit that provides air ambulance services to the province and for-profit companies that pursue other ventures. Mazza, according to the company, primarily works for the latter and therefore is exempt from disclosing his salary. It’s such a “complicated corporate structure” that Matthews says she needs help to “better understand why it is that all salaries at ORNGE are not covered in the (public disclosure) act.” Boy, with my MBA and Medical Background, I could handle the reins of a business executive at Ornge for much less money :)

Rotman MBA, University of Toronto's LipDub Music Video for MBA Games 2012

2012-01-03T10:55:00.001-05:00

DeGroote MBA, McMaster University LipDub Music Video for MBA Games 2012

2012-01-03T10:46:00.001-05:00

Ryerson MBA Lipdub for MBA Games 2012 (Ted Rogers School of Management, Toronto, Canada).

2012-01-03T10:10:00.000-05:00

ORNGE recently spent $600,000 on degrees for 7 top executives. Excellent investment, folks :)

2011-12-29T12:55:00.001-05:00

From the link:
http://www.thestar.com/news/canada/politics/article/1108186--star-investigation-ornge-spends-600-000-on-degrees-for-top-executives?bn=1

Quote:

The ORNGE air ambulance service has recently spent more than $600,000 on university business degrees for top executives. In the last year, at least seven ORNGE officials have received or are enrolled in an executive MBA from a top Canadian business school. An ORNGE spokesman defended the practice, saying the executives are “high performers” and funding the business degrees helps ORNGE “attract and retain top quality talent.” ORNGE, which employs 400 people, receives $150 million in public funding each year.

The business schools include:

Schulich School of Business

Ivey School of Business

Business School in Brussels

What I understand ----> MBAs are valuable and well respected in the Healthcare Management Industry.

air ambulance aviation Frequently Asked Questions

2011-12-27T13:26:00.000-05:00

Shortage of paramedics leaves ORNGE helicopter idle

2011-12-20T22:32:00.002-05:00

From the link: http://www.thestar.com/news/canada/article/1104576--shortage-of-paramedics-leaves-ornge-helicopter-idle?bn=1

The air ambulance helicopter at ORNGE’s Thunder Bay base was grounded hundreds of times this year because no paramedics were available for emergency flights.

“No medics again,” the helicopter pilot recorded in his flight log, listing a nine-hour span when the helicopter and its two pilots were forced to sit idle in a hanger, unable to answer emergency calls.

ORNGE, paid $150 million annually by Ontario, has a helicopter and two airplanes at its key northern base but only enough paramedics for two of the aircraft.

ORNGE insiders have told the Star the frequent removal of medics from the helicopter is risky because only a chopper can provide service if there is a road accident or injury in a remote area. ORNGE airplanes typically move patients from one hospital to another.

“Medics poached,” another chopper pilot wrote in the electronic log book in May, recording a seven-hour lapse in service.

ORNGE spokesman James MacDonald said paramedics are not “vehicle specific.”

He said the paramedics staff the vehicle most appropriate for a trip. ORNGE will not provide the Star with any information on specific emergency calls that may have come in when the helicopter was unavailable.

The Star has been unable to determine if emergency calls came in for the helicopter during the time it was listed as unavailable.

Helicopter log entries obtained by the Star show there were 237 times over 10 months between February and November 2011 that the Sikorsky air ambulance helicopter and its two pilots sat in Thunder Bay listed as out of service. Without paramedics the pilots are unable to pick up injured patients and must notify the Toronto command centre they are unavailable.

The pilot logs, filed to ORNGE’s communication centre in Toronto, reveal that over the 10 months the chopper was grounded a total of 1,300 hours or 47 days — as many as 28 hours in one case in September. The average time the chopper was unavailable was five hours.

ORNGE’s Thunder Bay “Transport Medicine Centre for Excellence” was opened in late 2010 with much fanfare, promising the “highest level of medical care” for Ontario’s northern residents. Sixty per cent of ORNGE’s flights are north of Sudbury. The union that represents the paramedics is concerned that ORNGE’s decision has or will affect patients.

Ron Smith, director of transportation for a unit of the Canadian Auto Workers representing ORNGE’s 170 paramedics, said he knew this was a problem but did not know the chopper was out of service so many times. Smith said that an extra team of paramedics should be based in Thunder Bay to ensure the helicopter is always staffed. “If someone needs the helicopter it will be for an emergency like an accident on a road or in the bush where a plane cannot land.”

“It’s also a waste of public money,” Smith said. “You have a helicopter and two pilots sitting there unable to do their jobs.” To prepare this story the Star has spoken to a dozen ORNGE insiders. None of them can be identified because they have all been required to sign non-disclosure agreements and say that if they were named they would be fired and sued by the company. ORNGE spokesman MacDonald confirmed the existence of non-disclosure agreements and said that is part of their agreement with the province of Ontario and is in place to protect confidentiality of patients.

ORNGE spokesman MacDonald said last week that ORNGE places “paramedics on the most appropriate and efficient vehicle to meet the patients needs.” He said airplanes are often the better choice because they can fly longer than helicopters and in more adverse weather.

MacDonald emailed the Star Monday to cancel a scheduled interview with ORNGE’s president Chris Mazza, saying that “we are not satisfied that the Star intends to fairly and responsibly report on ORNGE.” MacDonald’s email came the day the Star published a story revealing that a group of ORNGE executives, including Mazza, work for a for-profit consulting company that has a $6.7 million contract to provide marketing services for AgustaWestland, the company that sold 10 helicopters to ORNGE for $120 million.

Later in the day Monday, MacDonald emailed a follow-up response regarding the Star’s earlier questions about Thunder Bay and the lack of paramedics for the helicopter.

“Your question describes a scenario that applies to all of our resources: if they already have a patient on board, then that aircraft — fixed or rotor — is unavailable for another call until the current patient is handed over to the hospital,” MacDonald wrote. “We believe the facts speak for themselves: our Thunder Bay crews have the ability to respond on either aircraft as appropriate; triage decisions are backed by transport medicine physicians; as a result of this system, we reached 57 per cent more patients from this base with the same funding. This clearly has had a positive impact on patient care in northwestern Ontario.”

Healthcare Reform in Canada

2011-11-05T22:06:00.001-04:00

From the link:
http://www.thestar.com/opinion/editorialopinion/article/1079107--how-to-reform-health-care

The story has become too familiar: health-care spending is skyrocketing and governments are struggling to find money to pay the bills. With current trends, health care would account for 80 per cent of Ontario’s budget in 2030.

These “straight line of death” projections lead quickly to the conclusion that we either need new revenues (i.e. taxes) or we must reduce the number of services paid for by governments (i.e. privatize).

But neither of these is necessary. Years of investment to reduce wait times, improve the quality of care and introduce technological innovations have created a platform for transformative change that can produce real cost savings — all under the umbrella of our public system.

Governments need to manage change in the health-care system differently in order to reap these savings.
First, we need to look for disruptive innovations in the delivery of care. What’s happening in health care is similar to the transformations in other high-tech industries: roles evolve quickly, traditional service models change rapidly and regulations need urgent reform. We are now seeing brain surgery done on an outpatient basis in Toronto.

Second, costs per unit in health care are declining as they do in other high-tech industries in a fashion analogous to Moore’s Law. Yes, that’s right, health-care costs are going down in many areas. In many cases, these dollars are not being returned to governments. We must recover the financial benefits of these productivity gains.

Third, policy-makers should continue their ongoing focus on improving access and quality as costs decline. Health care is different from traditional industries and more like high-tech industries. When access and quality improve, the cost often drops.

Finally, high-tech industries like health care require flexible operational environments. Regulatory barriers need systematic review and removal to encourage further innovation.

These four approaches applied to health system transformation in five areas will produce short-term savings and build a health-care system that responds to continuous change in a sustainable way:
• Modernize the organization of hospitals by disrupting existing models. Services in today’s general hospital could be provided more efficiently elsewhere: academic centres focused on excellent diagnostic work-ups; specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being for chronic conditions — an organized system with public funding and in partnership with traditional hospitals.
• Use virtualization to develop new roles for providers and patients. Virtualization allows health professionals to use the telephone, email and more breakthrough technology for patient interaction. Virtualization will also mean that health-care access will no longer be contingent on geography and region; this is critical in rural and northern regions. Like the ATM for banking, health virtualization fundamentally transforms how care is organized and delivered.
• Exploit digitization. After years of capital investment in health information technology, operational costs have begun to fall in areas like diagnostic imaging. Government must recover these savings and reinvest them. The next decade of IT modernization needs reformed provincial agencies that respond quickly to technological change and provide more IT funding directly to care providers. We urgently need to support grassroots innovation in health care, such as smart phones and tablets to enable doctors to communicate and deliver treatment more quickly.
• Change some governance structures. Ontario does not need a major round of restructuring, for example, by reinventing LHINs from scratch. Policy-makers should strengthen regional bodies, specialty care networks, and support mergers and acquisitions that build scale.
• Reform the way health services are purchased. The health-care pricing system is fundamentally broken. Global budgeting for hospitals and inflation in fee-for-service payments for doctors need to be urgently reformed in most provinces. The current system has allowed the benefits of productivity gains to accrue largely to providers, when more of the benefits should be returned to funders through lower prices.
These reforms do not rely on new revenues or any form of privatization to create a fiscally sustainable system.

They could all take place within the Canada Health Act and are consistent with its principles.
Discussions of new revenues or privatization distract policy-makers from tackling the main task of transforming health systems. Canadian governments should treat health care as the high-tech industry it is and accept that rapid change is a good thing for patients. These reforms will improve services for patients and strengthen Canada’s world-class health system.

Will Falk is executive fellow in residence at the Mowat Centre at the University of Toronto. He is lead author of a new report, Fiscal Sustainability and the Transformation of Canada's Healthcare System.

www.machealthmanagement.com (MHM: Master of Health Management program at DeGroote SOB, McMaster University).

2011-11-05T21:58:00.000-04:00

Welcome from Faculty and Students from Inspired One - New Media on Vimeo.

MHM program (Master of Health Management) is online & was started only in 2010 !!! : More information in video...

2011-11-05T21:56:00.002-04:00

Welcome from The Co-Directors from Inspired One - New Media on Vimeo.

Top 50 MBA in Healthcare Management Schools in USA.

2011-10-31T03:10:00.002-04:00

From the link:
http://master-degree-online.com/top-50-mba-in-healthcare-management-schools/

1. Northwestern University Kellogg School of Management has Health Enterprise Management.
2. UC Berkeley Haas School of Business
3. Johns Hopkins University
4. Baylor University
5. Boston University School of Management
6. Duke University Fuqua School of Business
7. Yale University School of Management
8. University of Colorado/Denver Business School
9. University of Iowa Tippie School of Business
10. University of Miami
11. University of Michigan Ross School of Business.
12. University of Scranton The school has initiated an online degree option
13. University of Pennsylvania Wharton School of Business
14. Saint Louis University Cook School of Business
15. Temple University Fox School of Business
16. Texas Tech University Rawls MBA Program
17. Georgia State University Institute of Health Administration
18. Union College Graduate School of Management
19. University of Washington Foster School of Business
20. University of Phoenix School of Business
21. CUNY Baruch College
22. Tulane University Freeman School of Business + the School of Public Health and Tropical Medicine
23. Herzing University
24. George Washington University has an online version
25. Cornell University College of Human Ecology offers the Sloan Program in Health Administration + Johnson Graduate School of Management.
26. Keiser University . This distance learning program
27. University of Houston/Clear Lake
28. Argosy University
29. Texas State University/San Marcos McCoy College of Business Administration
30. South University
31. Baker College makes the MBA in Healthcare Management available online
32. Fairleigh Dickinson University
33. American Intercontinental University
34. State College of New York/Binghamton (SUNY)
35. Eastern University has a Fast Track MBA in Health Administration
36. Loyola University of Chicago Graduate School of Business
37. Duquesne University Donahue Graduate School of Business
38. Vanderbilt Owens Graduate School of Management
39. Rice University Jones Graduate School of Business
40. Wake Forest University Schools of Business
41. University of Utah Eccles School of Management
42. Claremont Graduate University Drucker & Masatoshi School of Management
43. Hofstra University Zarb School of Business
44. Cleveland State University
45. DePaul University
46. Lamar University is part of the Texas State University system, located in Beaumont, TX. The School of Business.
47. Simmons College School of Management.
48. Adelphi University
49. Gonzaga University .
50. University of Southern California Marshall School of Management

The Emerging Market for MBAs in Health Care

2011-10-31T03:09:00.002-04:00

Link for article:
http://knowledge.wpcarey.asu.edu/article.cfm?articleid=1583

Extract:
The morphing MBA job market makes sense, as hospitals and other health care providers, both for-profit and non-profit, strive to cut costs while still giving good patient care. For a snapshot of the growing cost equation, consider this: health care costs have increased an average 2.5 percent more than the U.S. gross domestic product since 1970, according to a federal report published last August.

Both pharmaceutical firms and health care providers, including hospitals, are hiring an increasing number of MBAs, according to a white paper by MBA Focus, a Dublin, Ohio, consulting firm. Author Greg Ruf writes that "new firms are entering the MBA talent sweepstakes as they begin to recruit both new and experienced MBAs to their management." Until recently, MBA graduates, especially those from top-tier business schools, were snapped up by investment banks and consulting firms, but that is changing, Ruf noted.
Is he correct? A March 26 search of online employment database Monster using key word "MBA" in health care sectors pulled up more than 5,000 current job openings.

"The possibilities for management in health care are endless - there are so many directions you can go with the training. Hospital, pharmaceuticals/biotechnology, insurance, consulting etc"... I definitely see a health care preference among our MBA students. Many of the MBA students who want to work in this environment are driven by altruistic reasons, rather than money -- they want to help society.

The Healthcare MBA: One Fast Track in a Slow Economy

2011-10-31T03:08:00.002-04:00

Article about Health Sector MBA at the link below:
http://www.bnet.com/article/the-healthcare-mba-one-fast-track-in-a-slow-economy/266849

Extract:
The healthcare track for MBAs has never been a hot one — until now. Believe it or not, healthcare companies can’t find enough MBAs to fill open positions in this $2.26 trillion industry, says Marjorie Baldwin, head of Arizona State University’s School of Health Management and Policy. Hospital administration and healthcare practice management may still lack the glamour of top consulting gigs, but the opportunities now go beyond just hospitals - B-school grads can find roles in everything from biomedical startups and e-health ventures to consulting and pharmaceutical R&D.

Even as the country overall lost another 598,000 jobs in January, according to the Bureau of Labor Statistics, healthcare was one of just three industries to expand its workforce. In fact, healthcare services added 372,000 jobs throughout 2008, and a good chunk of those were on the business side. At Kaiser Permanente, for example, a third of the 16,000 to 18,000 positions that open up each year are in management and operations.

Most lucrative jobs:

The most popular positions for MBAs in the healthcare industry, according to Payscale, Inc. (Salaries represent 2008’s national median pay.) Hospital Administrator: $112,000 Healthcare Consultant: $99,500 Pharmaceuticals Project Manager: $91,900 Healthcare Services Director of Program Management: $89,000 Practice Manager: $87,300

Major MBA recruiters:
IMS Health
Amedisys
Amgen: MBA Leadership Program + summer internships
HCA etc

Health Sector Management Degrees - Mark Allan, Director, HSM, BU, Boston, MA, USA.

2011-10-31T03:06:00.005-04:00

Article about Medical Concierge.

2011-08-04T00:44:00.000-04:00

Here is the link for some info about Medical Concierge. An interesting job description.
http://www.indiatimes.com/photostory/9470492.cms

Top 25 Dot-Edu Resources for Health Administrators

2011-07-14T07:16:00.000-04:00

http://mastersinhealthadministration.org/2011/top-25-dot-edu-resources-for-health-administrators/

Check out this link for article on "Top 25 Dot-Edu Resources for Health Administrators".

Health Insurers Making Record Profits as Many Postpone Care

2011-05-14T13:58:00.000-04:00

From the link:
http://www.nytimes.com/2011/05/14/business/14health.html?_r=1

The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care.

The UnitedHealth Group, one of the largest commercial insurers, told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna, another insurer, talked about the “low level” of medical use.

Yet the companies continue to press for higher premiums, even though their reserve coffers are flush with profits and shareholders have been rewarded with new dividends. Many defend proposed double-digit increases in the rates they charge, citing a need for protection against any sudden uptick in demand once people have more money to spend on their health, as well as the rising price of care.
Even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans’ appetite for health care.
“I am noticing my patients with insurance are more interested in costs,” said Dr. Jim King, a family practice physician in rural Tennessee. “Gas prices are going up, food prices are going up. They are deciding to put some of their health care off.” A patient might decide not to drive the 50 miles necessary to see a specialist because of the cost of gas, he said.
But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.
For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”
Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.
In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.
Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.
High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. Mr. Welch, who has been a supporter of the need to overhaul insurance industry practices for the California Nurses Association union, said he hoped his medical training would help him determine when to go to the doctor. “I underestimated how much that cost would affect my behavior,” he said.
Dr. Rebecca Jaffe, a family practice doctor in Wilmington, Del., said more patients were asking for the generic alternatives to brand-name medicines, because of hefty co-payments. “Now, all of a sudden, they want the generic, when for years, they said they couldn’t take it,” she said.
The insurers, which base what they charge in premiums largely on what they expect to pay out in future claims, say they still expect higher demand for care later this year. “I think there’s a real concern about a bounce-back, a rebound, in utilization,” said Dr. Lonny Reisman, the chief medical officer for Aetna.
Because they say they expect costs to rebound, insurers have not been shy about asking for higher rates. In Oregon, for example, Regence BlueCross BlueShield, a nonprofit insurer that is the state’s largest, is asking for a 22 percent increase for policies sold to individuals. In California, regulators have been resisting requests from insurers to raise rates by double digits.
Some observers wonder if the insurers are simply raising premiums in advance of the full force of the health care law in 2014. The insurers’ recent prosperity — big insurance companies have reported first-quarter earnings that beat analysts expectations by an average of 30 percent — may make it difficult for anyone, politicians and industry executives alike, to argue that the industry has been hurt by the federal health care law. Insurers were able to raise premiums to cover the cost of the law’s early provisions, like insuring adult children up to age 26, and federal and state regulators have largely proved to be accommodating.
But 2014 and 2015 are likely to be far more challenging, as insurers are forced to adjust to the law’s greatest changes, like providing coverage to everyone regardless of whether they have an expensive pre-existing condition. “I think they’re going to go through a winter,” said Paul H. Keckley, executive director of the Deloitte Center for Health Solutions, a research unit of the consulting firm Deloitte.
And while the slowing down of demand is good for insurers, at least in the short term, the concern is that patients may be tempted to skip important tests like colonoscopies or mammograms. The new health care law will eventually prevent most policies from charging patients for certain kinds of preventive care, but some plans still require someone to pay $500 toward a colonoscopy.
In recent times, insurers have prospered by pricing policies above costs, said Robert Laszewski, a former health insurance executive who is now a consultant in Alexandria, Va. The industry goes through underwriting cycles where the companies are better able to predict costs and make room for profits. “They’re benefiting from a very positive underwriting cycle,” he said.

“Maybe managed care is finally working,” he said. “Maybe this is the new normal.”
Still, he emphasized, health care costs, even if they are rising at 6 percent or 7 percent a year, are increasing at a much faster pace than overall inflation. “We haven’t solved the problem,” Mr. Laszewski said.

A version of this article appeared in print on May 14, 2011, on page A1 of the New York edition with the headline: Health Insurers Profit as Many Postpone Care.

International SOS - Medical Evacuation & Repatriation services - Short clip.

2011-04-01T14:35:00.003-04:00

International SOS - For more of the funniest videos, click here

APOLLO HEART INSTITUTES - http://www.apollohospitals.com/

2011-04-01T14:30:00.002-04:00

Medical Tourism India - http://www.surgicaltourism.ca/

2011-04-01T14:28:00.001-04:00

Surgical Tourism Canada - http://www.surgicaltourism.ca/

2011-04-01T14:26:00.001-04:00

Surgical Tourism Canada - Oh. Canada!

2011-04-01T14:25:00.001-04:00

http://www.surgicaltourism.ca/

2011-04-01T14:24:00.001-04:00

Surgical Tourism Canada.
http://www.surgicaltourism.ca/

MBA after MBBS (Medical) degree from India. A good path for doctors from abroad (Foreign Medical Graduates).

2011-04-01T13:22:00.001-04:00

Health Sector Management MBA - Duke University - Fuqua School of Management.

2011-04-01T12:57:00.001-04:00

Boston University student - MBA'11, Health Sector Management MBA

2011-04-01T12:56:00.001-04:00

Boston University student - MBA'11, Health Sector Management MBA

2011-04-01T12:54:00.002-04:00

Admissions Tip: Healthcare Management Studies

2011-03-29T23:24:00.000-04:00

From the link:
http://gmatclub.com/blog/2010/07/clear-admit-admissions-tip-healthcare-management-studies/

Today we turn our attention to options for studying healthcare in business school, with a particular emphasis on Wharton’s Health Care Management Major and Duke’s Health Sector Management Program, the two oldest and best known healthcare programs among U.S. business schools.

Wharton’s major draws its faculty from the business, medical and nursing schools, as well as from practicing healthcare professionals, ensuring an interdisciplinary approach to the issues in the field. The Health Care Management major differs from other majors at Wharton in that students must choose the major in their initial application to the school instead of in their second year. Health Care Management further differs in that it aggressively integrates professional development and field work into the major.

For instance, all Health Care majors are required to complete a Field Application Project (FAP). In the FAP, teams of students spend a semester working with an industry partner to solve real world problems in the healthcare field. Given the amount of time these projects can take, students must work carefully to balance classes around the demands of their projects.

At Fuqua, students enter the HSM program from a variety of backgrounds; though the program does not require prior health sector experience, it does look for a strong commitment to the healthcare field among all participants. As with Wharton’s Health Care Management major, application to Fuqua’s HSM program is through the MBA admissions process, with HSM applicants asked to indicate their interest in pursuing the HSM Certificate in a special section of the application.

Once enrolled, Duke HSM students spend the first year completing the standard core curriculum before beginning the coursework that leads to the HSM Certificate. To earn the Certificate, HSM students take three HSM core courses and three healthcare electives. All six HSM courses count as elective credits towards the MBA degree requirements. This is a slightly heavier courseload than required by Wharton’s healthcare program, which asks students to complete two foundations courses and three healthcare electives.

Despite the prominence of the Wharton and Duke programs, they are far from the only option for MBA applicants seeking a career in healthcare. For instance, Columbia now offers the Health Care and Pharmaceutical Management program, Kellogg offers a major in Health Industry Management, and HBS hosts the Healthcare Initiative. Those business schools that do not offer formal healthcare concentrations tend to have a student club and/or a student-organized conference dedicated to supporting interest in the field, so regardless of the program, healthcare minded applicants should find plenty of resources.
For more on healthcare options, majors, student clubs or conferences, be sure to check out the Clear Admit School Guides.

For those who are interested in pursuing a career in healthcare and want to learn more about the different programs and opportunities available at each school, check out the Clear Admit Career Guide: Healthcare.

Reactivating this blog!

2011-03-26T18:50:00.001-04:00

I had not blogged here for a while. Had taken a break and got lost in the MBA program. Its time to restart this now. I hope to blog here on a regular basis now on!

Gerry.
MBA blog: www.gerry.in
MBA application experience blog: www.top-mba.com

Advantage of being an IMG in Canada & USA.

2010-05-08T10:44:00.002-04:00

While the disadvantages are obvious and numerous - as depicted in various Canadian news papers and TV channels from time to time, with occasional shedding of (?crocodile) tears - both for the apathy of IMGs as well as the lack of care for local populace - there are certain advatages that IMGs do have too.

* Most IMGs do not have student debt from their home countries. While local students rack up huge loans - anywhere from $150,000 to $300,000 for their medical school, a lot of IMGs however, do not have such problems. Especially those who got their seat on merit basis in their home countries. Since countries like India, Pakistan, Bangladesh are not heavily credit driven societies - as compared to the West, most of the expenses are covered by funds loaned by parents and / or friends / relatives.

* A lot of IMGs do not have to go through the pre-Med program, thus saving 3 years there.

Thus, an IMG, who has saved time and money, should seriously consider residency / training in Canada & USA. For residency, there is no tuition fee. Instead, a resident is paid a salary / stipend of $4000 in Canada and approx US$.3300 in the US, which is ok, since they earn $150,ooo+ a year upon completion of residency.

It is said that "patience is bitter, but the fruits are sweet". This is definitely true when it comes to IMGs.

Jan 1992 Banff: Too many doctors in Canada. A threat!!! That was what they thought then. Slash MD numbers in Canada, they decided. Bad decision!

2010-05-08T10:26:00.008-04:00

Desperately Seeking Doctors in Canada 1 (click twice on video to see video in YouTube itself)

2010-05-08T10:22:00.005-04:00

Canadian Doctor Lotteries: Sad state of affairs! Not all patients can see an MD in Canada :( Yet IMGs drive cabs. This is bullshit!

2010-05-08T10:16:00.005-04:00

Doctor shortage in Canada & difficulties of IMGs in Canada

2010-05-08T10:13:00.001-04:00

Canadian $150,000 bonus to work in Belleville ON. Hey, I could use that kinda money in USA / Canada !

2010-05-08T08:41:00.002-04:00

National Society of Certified Healthcare Business Consultants

2010-05-03T10:56:00.002-04:00

National Society of Certified Healthcare Business Consultants.
"Professionals in the business of healthcare"
www.nschbc.com

CHE & FCCHSE Designations

2010-04-29T12:00:00.000-04:00

The promotion of excellence in health leadership is at the core of all the College's work, and professional certification is the most valuable and visible way that members demonstrate they have achieved a proven level of knowledge and experience. By earning the Certified Health Executive (CHE) designation, members enhance their professional image, increase their knowledge, and achieve their potential by demonstrating to employers and colleagues that they are a trusted resource. Some go on to become a Fellow of the College, the highest designation awarded for outstanding career and professional achievement.

Only members (individual member category) in good standing may apply.

www.CCHSE.org

2010-04-29T11:58:00.002-04:00

Founded in 1970, the Canadian College of Health Service Executives (CCHSE) is a national, non-profit, professional association dedicated to developing, promoting, advancing and recognizing excellence in health leadership. Our 3,000 individual and 80 corporate members work in all health sectors across the country.

We offer a wide range of services including a competency-based certification program, a forum for the exchange of information and best practices, a career network, and an extensive national program of professional development resources and opportunities. We also publish the only peer-reviewed journal that covers issues related to advances in health services management, theory and practice in a Canadian context.

Our contribution to the health system and, ultimately to the health of Canadians, is through the leadership excellence of our members.

Canadian College of Health Service Executives
292 Somerset Street West, Ottawa, Ontario K2P 0J6
Telephone: (613) 235-7218Fax: (613) 235-5451 Toll Free: 1 800 363-9056

Useful Resources - Healthcare Organizations in USA

2010-04-29T11:38:00.003-04:00

Some of these resources include:

American Association of Health Plans1129 20th St. N.W., Ste. 600Washington, DC 20036(202) 778-3200
American Association of Healthcare Consultants11208 Waples Mill Rd., Ste. 109Fairfax, VA 22030(703) 691-2242
American Association of Homes and Services for the Aging901 E St., N.W., Ste. 500Washington, DC 20004-2037(202) 783-2242
American College of Healthcare Executives 1 N. Franklin St., Ste. 1700Chicago, IL 60606-3529(312) 424-2800
American College of Medical Practice Executives104 Inverness Terrace, E.Englewood, CO 80112-5306(303) 799-1111
American College of Physician Executives4890 W. Kennedy Blvd., Ste. 200Tampa, FL 33609-2575(813) 287-2000
American Hospital Association1 N. Franklin St., Ste. 2700Chicago, IL 60606(312) 422-3000
American Organization of Nurse Executives1 N. Franklin St., Ste. 3400Chicago, IL 60606(312) 422-2800
American Public Health Association1015 15th St., N.W., Ste. 300Washington, DC 20005(202) 789-5600
Association of Behaviorial Healthcare Managers 60 Revere Dr., Ste. 500Northbrook, IL 60062(847) 480-9626
Association of University Programs in Health Administration 2000 N. 14th St., Ste. 780Arlington, VA 22201( 703) 894-0940
Canadian College of Health Service Executives 350 Sparks St., Ste. 402Ottawa, ON K1R 7S8 Canada(613) 235-7218
Canadian Hospital Association 17 York St., Ste. 100Ottawa, ON K1N 9J6 Canada (613) 241-8005
Commission on Accreditation of Healthcare Management Education 730 Eleventh Street, NW, Ste. 410Washington, DC 20001(202) 638-5131
Healthcare Financial Management Association Two Westbrook Corporate Center, Ste. 700Westchester, IL 60154(708) 531-9600

Making Your Career (as Healthcare Executive) Happen:-

2010-04-29T11:34:00.001-04:00

Here are some general guidelines to help you begin to set and achieve your career goals:

Investigate many educational programs—both graduate and undergraduate—before you make a commitment of time and money. (A list of links to CAHME-accredited graduate programs follows.) Programs vary widely from location to location. Some offer a broad summary of the field, while others provide training in managing specific kinds of organizations.

Develop your people skills. Your success as a healthcare executive will depend on your ability to get along with diverse groups of people: employees, physicians, vendors, governing boards, and the public. Learn how to motivate, negotiate, and manage.

Develop strong quantitative skills. Healthcare executives must understand financial strategies and accounting principles, and they must be able to interpret data.

Stay current on healthcare trends. Be aware of shifting opportunities resulting from changing demographic and reimbursement trends to developments in healthcare policy

Read about healthcare. You can find interesting articles in local newspapers, national magazines such as Newsweek and Time, and trade publications such as Healthcare Executive, Frontiers of Health Services Management, Journal of Healthcare Management, and Modern Healthcare. Visit university libraries.

Learn about healthcare providers. Nearby hospitals, HMOs, and mental health facilities may offer free publications, health fairs, or community health education programs. If possible, tour a facility or participate in a volunteer program.

Be patient and flexible. You may have to relocate to another part of the country to take advantage of a specific educational program or job opportunity.
Identify your career goals and take steps to attain them. Determine your weaknesses and then develop a plan to correct them. Build on your strengths.

Use ACHE resources. The American College of Healthcare Executives provides access to the Online Directory of Fellowships in Health Services Administration, directories of local chapters, and participants in the ACHE Higher Education Network, and many other tools to help you network and develop your career.

Rely on the expertise of healthcare organizations.

Where Do You Start? (your career as Healthcare Executive)

2010-04-29T11:33:00.000-04:00

Begin planning as early as possible for a career in healthcare management. A good scholastic record is important—especially if you want to attend a graduate program for a master’s degree or a doctorate. Many schools and colleges in the United States and Canada offer undergraduate degrees with a concentration in health services management.

In the past, most students chose the traditional route of a master’s degree in health administration or public health. Today, however, students are investigating other options, including graduate degrees in business and public administration, with course concentration in health services management. Some schools offer a joint degree-a master’s degree in both business administration and public health, or in both healthcare management and law, for example.

Graduate programs generally last two years and lead to a master’s degree. They include course work in healthcare policy and law, marketing, organizational behavior, healthcare financing, human resources, and other healthcare management topics. The program may also include a supervised internship, residency, or fellowship.

To learn more about student involvement with the American College of Healthcare Executives, please consult the ACHE Higher Education Network Directory. To learn more about post-graduate fellowships in healthcare administration, consult the Online Directory of Fellowships in Health Services Administration. You may also obtain information on how to apply as a Student Associate of the American College of Healthcare Executives.

Do You Have What It Takes? (to become a healthcare executive)

2010-04-29T11:32:00.002-04:00

What do employers look for in their entry-level managers?

Here are some of the criteria:

Academic training/previous work experience
A degree in health administration from a school accredited by the Commission on Accreditation of Healthcare Management Education or another degree that may qualify you (VERY IMPORTANT: ACCREDITED SCHOOL, NOT just ANY school! Don't waste your time, money & energy.)
A commitment to professional development and continuing education
Previous positions, internships, and fellowships in healthcare organizations or other business settings
Communication skills
Strong written and oral communication skills
Ability to develop and present reports and proposals
Adaptability/organizational fit
Personal and career objectives that mesh with those of the organization
Ability to work well with others, including superiors, subordinates, and peers
Attitude and appearance that communicate confidence, maturity, and competence
Dependability, judgment, character
Maturity to make decisions and take responsibility for them
Honest and ethical business conduct
Willingness to make a commitment to the organization
General management skills
Leadership that inspires and motivates others
Ability to train, delegate, evaluate, coordinate, and negotiate

Career Opportunities for Healthcare Executives

2010-04-29T11:31:00.001-04:00

This is an exciting time for healthcare management. The field requires talented people to help introduce and manage the changes taking place. In their roles, healthcare executives have an opportunity to make a significant contribution to improving the health of the communities their organizations serve. As a result of the transformation taking place in the healthcare system, career options for healthcare executives are becoming more diverse. Increasingly, positions for healthcare executives may be found in a wide variety of settings, such as:

Ambulatory care facilities
Consulting firms
Healthcare associations
Home health agencies
Hospices
Hospitals and hospital systems
Integrated delivery systems
Long-term care facilities
Managed care organizations (such as HMOs and PPOs)
Medical group practices
Mental health organizations
Public health departments
University or research institutions

Today, an estimated 100,000 people occupy health management positions at numerous organizational levels, from department head to chief executive officer. Requirements for senior-level positions in healthcare organizations are demanding, but these jobs also offer opportunities to improve the system of care giving.

With the growing diversity in the healthcare system, many executives are needed in settings other than the traditional hospital. However, competition is intense at all job levels, and many positions that previously required only a bachelor’s degree now require a master’s degree. Each year, about 2,000 students receive graduate degrees in healthcare management. Salaries for beginning master’s degree graduates generally range from the high-30s to high-40s, depending on the type of organization and its location. If you choose a career in healthcare management, your first job might be an entry- to mid-level management position in a specialized area, such as:

Finance
Government relations
Human resources
Information systems
Marketing and public affairs
Materials management (purchasing of equipment and supplies)
Medical staff relations
Nursing administration
Patient care services
Planning and development

Healthcare: A Changing System

2010-04-29T11:30:00.000-04:00

Healthcare is changing more rapidly than almost any other field. The field is changing in terms of how and where care is delivered, who is providing those services, and how that care is financed. These changes are being driven primarily by the growth of managed care. A number of other current trends are expected to continue, including:
Integration of healthcare delivery organizations to create accessible, appropriate, and comprehensive care pathways for all people
Continual advances in medical technology
Collaboration among provider organizations, physicians, businesses, insurers, and others to improve community health status
Increased emphasis on disease prevention and wellness promotion
An elderly population that will grow exponentially with the "Baby Boomer" generation
Better-informed patients demanding high-quality care
Pressure from business, government, insurers, and patients to control costs and demonstrate the value of the services delivered
Efforts to implement continuous quality improvement initiatives similar to those found in other fields

Your Career as a Healthcare Executive

2010-04-29T11:29:00.000-04:00

You will make decisions about your career throughout your life. No matter what stage of the decision-making process you are in, we hope that this essay will give you a better understanding of the exciting profession of healthcare management. Healthcare is one of today’s most dynamic and growing fields, with a wide range of opportunities and challenges. Healthcare executives work in a variety of settings, including hospitals and integrated delivery systems, managed care organizations, long-term care facilities, home health agencies, and consulting firms, to name a few. The American College of Healthcare Executives wants to help you make a positive, informed decision about your career. You can count on us as a resource for career advice, resume consultation, continuing education, and other career services.

Thomas C. Dolan, Ph.D., FACHE, CAE
President and Chief Executive Officer
American College of Healthcare Executives

www.ACHE.org (American College of Healthcare Executives)

2010-04-29T11:26:00.004-04:00

Certification as FACHE (Fellow) is possible after writing the precribed exam.
Eligibility criteria:-
* Master's degree (in Healthcare Management field from an ACCREDITED School)
* Hospital management experience (minimum of 2 years)
* Current / recent hospital management position (in USA?)

American College of Healthcare Executives
The American College of Healthcare Executives is an international professional society of 30,000 healthcare executives. ACHE is known for its prestigious credentialing and educational programs and its annual Congress on Healthcare Management, which draws more than 4,000 participants each year. ACHE is also known for its journal, the Journal of Healthcare Management, and magazine, Healthcare Executive, as well as ground-breaking research and career development and public policy programs.

ACHE’s publishing division, Health Administration Press, is one of the largest publishers of books and journals on all aspects of health services management in addition to textbooks for use in college and university courses.

Through such efforts, ACHE works toward its goal of being the premier professional society for healthcare leaders by providing exceptional value to its members.

Medical Office Assistant Training (College training to Bachelors to Masters degree path)

2010-04-29T08:22:00.002-04:00

A Career in Hospital Management (especially w.r.t. India)

2010-04-29T08:08:00.004-04:00

From the link:
http://www.rxpgonline.com/article1081.html

Health Management is among the top ten millennium professions according to a recent US survey. As healthcare management is becoming increasingly privatised there is a greater need for not only skillful doctors but also efficient hospital administrators. If hospitals have always fascinated you rather than scaring you off and you have an empathic nature along with a flair for organisation and an eye for detail then you can consider a career in Hospital Management. A large number of private hospitals and clinics have come up all over the country. With increasing emphasis on quality of health care and patient satisfaction there is a tremendous need for persons with a professional qualification in Hospital Management.Professional courses in Hospital Management/Administration are available for both medical and non-medical persons.

TOPICS COVERED :Some of the topics covered in the professional programme are as follows :

Administration of Hospital and Health Care Planning.
General & Personnel Management in Health Institutions.
Concepts of Epidemiology (Public Health Administration), Anatomy, Physiology and Medical Terminology.
Financial Management & Inventory Control in Hospitals.
Behavioural Science (Organizational Behaviour in Hospitals).
Organization & Management of Hospitals.
Health Management Information System.
Hospital Policies, Practices, Acts & Committees : Bhore & Mudalior - Reports, Hospital Committee Reports & National Health Plans. (Industrial Relations, Employees Welfare, Trade Unions, Labour Laws).
Counselling.

THE WORK :
As a Hospital Administrator you will be responsible for the overall organisation and management of the hospital to ensure its smooth functioning with the objective of ensuring the complete satisfaction of the patient. You will have to co-ordinate between the various departments of the hospital, ensure that all the equipment is functional, that there is a smooth flow of medical supplies and above all the required standards of cleanliness are maintained. You will also deal with the employees and financial matters.The emphasis is on quality, efficiency and cost containment. The challenge is to deliver the highest quality care at the lowest cost. It entails giving 100% of your time to quality in-patient care, lowering the length of stay, decreasing resource utilisation and working with the medical and administrative staff to co-ordinate all aspects of in-house care.

JOB OPPORTUNITIES :
Following the professional course you can avail of challenging job opportunities in medical institutes, hospitals, nursing homes and NGOs operating in the health care sector.Over one-half of all jobs in this field are in hospitals. The remainder are in home health agencies, medical and dental laboratories, offices of dentists and other practitioners, and other health and allied services. New graduates with Master's degrees in health services or hospital administration may start as assistant hospital administrators, or as managers of non-health departments, like finance. Post-graduate residencies and fellowships are offered by hospitals and other health facilities; these are normally staff jobs. Graduates from Master's degree programs also take jobs in hospitals, large group medical practices, clinics, mental health facilities, and multi-facility nursing home corporations. Health service managers advance by moving into more responsible and higher paying positions such as assistant or associate administrator and finally, CEO, or by moving to larger facilities.

More information at icscareersonline

Welcome, high-end patients (Medical Tourism in India)

2010-04-28T03:24:00.002-04:00

From the link:
http://in.news.yahoo.com/248/20100427/1611/tls-welcome-high-end-patients.html

When James Michael, 35, began trawling the Internet for an affordable option to US health care, the prompt response from Fortis Healthcare in Bangalore to his enquiries about cervical disc replacement surgery brought him to the hospital recently. Thousands of foreigners are choosing Indian hospitals for complex procedures, not just dental or cosmetic work as was the case when medical tourism started. "Today, India is getting travellers from around 35 countries as against mainly from neighbouring countries and West Asia five years ago," says Vishal Bali, CEO, Fortis Healthcare.

Fortis alone treats close to 2,000 American patients a year now between its Mumbai and Bangalore hospitals, or ten times the Americans it handled in 2005. Both Fortis hospitals are accredited to the JCI or the Joint Commission International, a nonprofit US body that sets standards.

Preetha Reddy, Managing Director, Apollo Hospitals, an early starter in medical tourism (the current term is 'medical value travel'), says that, five years ago, 80 per cent of the 'foreign' patients came from South Asia. "Today, it is down to 30 per cent with more patients coming in from a wide range of countries," says Reddy.

And it is not just the chains. Take HealthCare Global, a Bangalore-based cancer specialist. "Today, six per cent of our total patients come from abroad and this number is growing at 20 per cent per annum with patients mainly from Africa, Bangladesh, West Asia, Canada and some European countries like Norway and The Netherlands," says Dr B.S. Ajai Kumar, Chairman & CEO, HealthCare Global.

On the second day of his admission, doctors operated on Michael to replace a disc - a cushion between two bones - in the neck region with an artificial one.
Reddy says 300,000-odd medical tourists visited India last year, of which more than half are estimated to have headed into wellness centres promoted by locations like Kerala. But there is a clear trend among the rest towards tertiary care.

That a patient with a serious health problem is willing to take a 24-hour flight for treatment indicates a coming of age for the sector, which has been investing in facilities and techniques.
Dr G.S. Rao, Managing Director, Yashoda Group of Hospitals, which has units in Hyderabad and Secunderabad and is the first in South Asia to offer rapid arc radiation therapy, cites another factor attracting longdistance patients. "We have seen a perceptible increase in patients inflows with the new international airport coming up in Hyderabad," he says.

When Michael and his wife finally checked out of Fortis, the bill was $15,000, including a week's stay in a five-star-like facility, against the US rate of $30,000-40,000.
The cost differential is a major attraction. A cardiac bypass procedure, for instance, would cost around $8,500 in India, including stay for one companion in a single room. The US cost: around $100,000. On an average, treatment costs here are 10-20 per cent of US levels.
Medical value travel is worth $700 million now. "India accounts for no more than 1.2 per cent of the global market by value," says M. Muralidharan Nair, Partner, Business Advisory Services Practice, Ernst & Young (E&Y). Despite the growth potential, he says, the market size in 2012 will be much below $1.5-2.2 billion projected by some studies.

The number of international patients coming to India has grown at more than 24 per cent each year since 2002 and over half a million are expected to have visited by the end of last year. India apparently is also gaining from a transformation in this space globally.
"Medical tourism has transitioned from a cottage industry to an acceptable alternative for elective care that's safe and cost-effective, if coordinated by reputable health plans and providers," says Paul H. Keckley, Executive Director, Deloitte Center for Health Solutions, in its 2009 report Medical Tourism: Update & Implications.

Indian hospital chains are not waiting for patients to turn up: Some, like Fortis, Apollo and HealthCare Global are setting up outposts abroad to catch the tide. Recently, Fortis acquired a strategic stake in Singaporebased Parkway Holdings. Malvinder Mohan Singh, Fortis Chairman, told BT: "Singapore is an international medical hub and international patients are an important component for Parkway. Now we could attract patients into our network to service them out of Singapore, Malaysia (where Parkway also has a strong presence) and India."
After checking out, Michael took an autorickshaw to some shopping areas in Bangalore, India's Silicon Valley. It was a smooth ride.

Not so for the hospitals. Matching the West's expertise or equipment is not a problem, but the bugs are vexing. Take insurance. If an American tourist in India on vacation or work has a heart attack and undergoes an emergency procedure, the tourist's insurer picks up the tab. But the same insurer will not pay for elective surgery here.

Then, India has very few JCI-accredited hospitalsâ€”just over a dozen. India also needs a deeper pool of highly-skilled manpower attuned to diverse cultures. There is more to it than just providing an American with an Internet connection, an European a diet brief or an Arab a prayer room.

Attracting the best
India gets patients from around 35 countries today; five years ago, most were from neighbouring countries and West Asia.
Foreign patients now taking 24-hour flights to India to seek treatment for life-threatening conditions. Earlier, it was for cosmetic surgery.
Healthcare players are investing in the latest technologies, conducting beating heart surgeries and using robotics.
Some international healthcare insurance entities have started offering options to cover elective procedures in India.

But the potential for getting more patients from the West is huge: Nair of E&Y points out that over half the medical tourists now still are from countries such as Bangladesh, Pakistan and Nigeria, and India has been able to attract only 12 per cent of the medical travellers from the US, UK and West Asia, who account for a quarter of global medical travellers.

Prescription for Growth
Speedier grant of medical visa, even visa on arrival.
Better linkages between healthcare and tourism.
Better airports and roads, not just in pockets but at all locations. More hospitals accredited to the JCI.

Reproduced From Business Today.

MBA after Medicine: Career in Mangement for Doctors

2009-11-07T11:16:00.002-05:00

From the link:
http://www.successcds.net/MBA-Admission/MBA-After-Medicine-MBBS.html

MBA after Medicine Career in Mangement for Doctors

MBA seems to be the most sought after post graduation option nowadays. So, if you are a doctor you must have contemplated this choice while thinking of MD or MS. There are many management specializations for medical students. If you are confused whether to change your profession as a doctor and become a manager then you should follow your aptitude. If you are very good as a doctor then you should pursue a MD or MS in the area of your interest. Or else, if you have good managerial skills then very well go for MBA where there is a lot of scope for you.

Doctors who go into management can find great jobs in hospital management and administration. There are big medical electronic companies like Philips or GE which would absorb MBA grads with a background of medicine. These companies develop products and services which can best be done by doctors. Besides, there is tremendous scope for clinical research. Doctors with management background can do a phenomenal job in terms of product development and management.

It is not necessary that you have to move away from your medical profession once you have a management degree. You can very well continue to practice. Infact, a doctor with managerial skills can provide the best treatment, which is cheapest for the patients. A MD/MBA integrated degree is very popular in the west. More and more students are showing interest in health-care management.

Considering the amount of money spent on becoming a doctor, it is necessary that you have the skills to earn as much (if not more) in as little time as possible; for which business knowledge is crucial. However good a doctor you may be, or however great your clinic is, you need patients to keep coming in and that requires planning and strategic overview of things. However, people in the medical community are not simply pursuing MBAs as a sort of one-stop shop for business education. There are also master's degrees in public health care and executive MBA programs for doctors.

Whatever said and done, a MBA degree will help you make money but not save a life, only clinical knowledge will help you do that. So, it is very essential that you practice as a doctor for not less then 5 years before you pursue a MBA degree.

You can find employment in hospitals and other healthcare organisations. The tasks would typically involve managing the staff, health services and containing the expenditure. While both medical and non-medical graduates can take up the course, medical graduates would be dealing more with the technical aspects of hospital administration.

Tata Institute of Social Sciences, Maharashtra offers Master of Hospital Administration. The eligibility criteria are graduation in any discipline with minimum 50 per cent marks and age not more than 45 years. The admission is based on entrance test, group discussion and personal interview. For details, visit www.tiss.edu

Manipal University, Manipal Institute of Management, Manipal offers MBA in Hospital Administration and Health Care Management. The eligibility criterion is graduation in any discipline with minimum 50 per cent marks. The admission is based on performance at Management Aptitude Test, group discussion and personal interview. For details, visit www.manipal.edu

Swapna Dilip Rasal

Stress on doctors in Canada

2009-10-24T07:06:00.003-04:00

Power Play in the Canadian Healthcare System

2009-10-24T07:04:00.003-04:00

Canadian Healthcare wait list...

2009-10-24T06:56:00.002-04:00

Canadian Doctor Lotteries

2009-10-24T06:55:00.003-04:00

Ad attacking Canadian Healthcare system

2009-10-24T06:54:00.003-04:00

Canadian Medical Tourism ... by Mackinac Center

2009-10-24T06:52:00.003-04:00

India: Medical Tourism Draws Attention Away From Disastrous Conditions At Most Hospitals in India

2009-10-16T00:08:00.003-04:00

By Jason Overdorf

NEW DELHI, India --
Seema sits cross-legged on a filthy sheet of cardboard next to a crumbling concrete planter in the central square of Nehru Place, New Delhi's computer and electronics hub. Four years ago, at the age of about 14, she gave birth to a son on this very spot, without the aid of a kettle of boiling water or a clean blanket, much less anesthesia or a doctor. Four days ago, the same little boy, Rajesh, died here, on the same slab of pavement.

Suffering from pneumonia, Rajesh never saw a real doctor, even though his mother and the community of rag pickers who live here scraped together everything they had to collect 500 rupees ($12) to pay for treatment. Not knowing any better, Rajesh's family took him to an informal medical clinic on the outskirts of town -- the only private medical care that they thought they could afford. The staff there gave them some medicine. But nobody on site had any medical qualifications, so Rajesh wheezed and coughed himself to death.

"I gave birth right here," Seema said. "It was in winter. That's how Rajesh got sick in the first place. We took him to the doctor so many times. So many people's children I've seen die. They collect money from various places and go to the doctor, and the children still die."
Seema's grief echoes across the country. According to a new report by Save the Children, nearly 2 million children under 5 die every year in India -- one every 15 seconds -- the highest number anywhere in the world. More than half die in the month after birth and 400,000 in their first 24 hours. Devastating poverty is the root cause. But the full story is even more grim.

India has swiftly gained a global reputation for excellence in health care thanks to the thriving business of "medical tourism." But the patients jetting in from the U.K., the U.S. and other wealthy nations to take advantage of relatively low costs for planned surgeries like knee and hip replacements and cosmetic procedures have drawn attention away from the disastrous conditions at most hospitals -- not to mention the total dearth of health care for hundreds of millions of Indians.

And medical tourism has a dark side: it has encouraged wealthy and influential Indians to forget about the crumbling and overburdened government-run health system, because they now believe they have access to the world's best care from private hospitals.Read more at: http://www.huffingtonpost.com/2009/10/15/india-medical-tourism-dra_n_322778.html

As a result, the Indian government spends only 0.9 percent of its gross domestic product on health care, ranking 171st out of 175 countries in public health spending, according to the World Health Organization. It relies on the private sector, which contributes another 4.3 percent of GDP, to make up the shortfall. So even though state-run hospitals like the All India Institute of Medical Sciences (AIIMS) -- a renowned center that treats about 3.5 million patients a year for less than a dollar apiece -- do their best to care for everybody, the rich and poor alike often turn to private clinics.

These private players, which receive tax breaks and purchase land from the government at subsidized rates, make much of the charitable work they perform for India's underprivileged. But a recent Delhi High Court judgment against Apollo Hospital and a subsequent health department investigation suggests that at least some of these claims may be exaggerated or even false.

In September, the Delhi High Court slammed Apollo for failing to live up to its commitment to provide free treatment for the poor in 40 percent of its outpatient and 33 percent of inpatient business in exchange for concessionary land rates, saying, "The hospital has made a complete mockery [of the agreement]." According to the All India Lawyers Union, which brought the suit against the hospital, the Delhi government granted Apollo 15 acres of land for the token price of one rupee and spent about $3.5 million in public funds on the construction of the facility.

"The entire purpose of giving them the public land was frustrated," said Ashok Aggarwal, the lawyer who argued the case against the hospital.
According to a spokesperson for Apollo Hospitals, the corporation's charitable activities are significant -- including the performance of more than 50,000 surgeries and other interventions for poor children suffering from heart disease -- and the Delhi hospital in question averages about 60 patients admitted for free care every day.
Apollo Delhi also operates a mobile clinic for the poor that has treated 26,000 patients over the past decade, the spokesperson added.

Apollo is by no means the only alleged violator, according to the Delhi government health department, though the hospital's $300 million parent company's fame in medical tourism makes it the most recognizable name of the bunch. A day or two after the judgment against Apollo, health department officials revealed that many of the 40-odd hospitals that were given government land at reduced rates were not utilizing the beds intended for providing free treatment for the poor. About 350 out of 500 beds intended for charity patients were empty. At least part of the problem is that poor people like Rajesh's parents don't know that these private hospitals are obligated to help them. But they may know the ground situation better than activists and writers.

"Even if knew they [private hospitals] were supposed to, do you really think they would let someone like me come through the door?" Rajesh's mother asks bitterly.
The privatization of health care has other dismal consequences, too. Forty percent of the primary health centers are understaffed; India has fewer than one hospital bed per 1,000 people, compared with a world average of nearly four; and for huge swaths of the countryside medical treatment is simply not available.

At state-run hospitals, hundreds of patients line up in the emergency room to take advantage of free treatment, ensuring a long enough wait that desperately poor people like Rajesh's parents believe they're better off paying for fast service elsewhere -- even from a quack.
Reports of stray dogs, monkeys and rats wandering through the wards are commonplace, and every so often local newspapers highlight something more disturbing, like a manhole burbling with waste water in the center of a patient's room.

Though the elite's faith in the much-feted private hospitals remains unshaken, the truth is that not even the wealthy can escape unscathed from the drastic gap between supply and demand.
Just a few weeks before 4-year-old Rajesh died from untreated pneumonia, Col. Satyendra Nath Bhargava, 68, succumbed to organ failure after awaiting treatment for an apparent heart attack for five and a half hours in the emergency room of the Artemis Health Institute, a high-priced private hospital in the Delhi-satellite town of Gurgaon, Haryana, according to his son.

As a decorated veteran of India's 1962 war with China, he could have sought treatment in any number of army hospitals. But his wife, naturally, called an ambulance from the nearest facility. Once she got there, sometime in the middle of the night, the staff refused to administer any tests on her husband until she went home to collect 50,000 rupees in cash (about $1,000) for a deposit. After that, there was no doctor available. Only five and a half hours later, when one of the staff recognized the colonel's sister-in-law -- herself a well-known medical doctor -- did the hospital finally track down a physician. By that time, it was too late.

"These hospitals, because they are big corporates, think that they can do whatever they want," said Kanish Bhargava, the colonel's 36-year-old son. "I used to always say that private hospitals are very good, and that they look at you and take care of you [quickly]. But I'm sorry to say that they don't. It's a money-making racket."

Read more at: http://www.huffingtonpost.com/2009/10/15/india-medical-tourism-dra_n_322778.html

An interesting Health care song about insurance claim denial!

2009-08-09T17:01:00.003-04:00

Video 4: Single Payer Solution in the USA

2009-08-06T00:12:00.002-04:00

Video 3: Single Payer Solution in the U.S.

2009-08-06T00:11:00.002-04:00

The Emerging Market for MBAs in Health Care

2009-08-05T23:21:00.002-04:00

The Emerging Market for MBAs in Health Care
Published: April 03, 2008 in Knowledge@W.P. Carey

From the link:
http://knowledge.wpcarey.asu.edu/article.cfm?articleid=1583

Unlike many of her peers who are investing precious time and money studying for a master's degree in business administration, Emily Pursell doesn't want to work for or a top consulting firm or hedge fund when she graduates.

Instead, Pursell, 30, will likely remain at New York Presbyterian Hospital, a non-profit organization that encompasses five centers and 2,335 licensed beds. She's already working there as a strategic sourcing specialist in the procurement department. There, she is key to an innovative supply chain initiative that is saving her employer money while improving patient care. But when she decided to get a graduate degree, Pursell opted for the master's of business administration degree rather than a public health degree.

"When I applied for graduate school, I wrote my entrance essay about all these MBA people who are going to work for financial institutions. I want to bring myself, with more value, back to my health care institution," she said. "Hospitals are trying to recruit top-level talent and be more competitive when it comes to hiring for financial management. At this point, having an MBA in a health care institution is an exception rather than a rule, as it is in the private sector. It renders me a little more rounded." She plans to graduate from Fordham University's MBA program in May, 2009.

New roles for MBAs

She is not alone, according to Eugene Schneller, a professor in the W. P. Carey's School of Health Management and Policy. He noted that many health care organizations are looking outside of health care for their talent. "At ASU," he pointed out, "we are committed to fast-tracking our graduates into these top jobs -- and the field is responding."

"There is a whole new set of roles in health care for MBAs, especially those with some clinical understanding. And those who have some knowledge about the distinct features of the health care system, such as its financing and the unique roles that physicians play, are in an even better position to win the leadership positions in major health care organizations. The best hospital systems have engaged MBAs successfully already," he noted.

The procurement or supply-chain department is only one of the areas where MBAs are being recruited. Schneller points out that "Many graduates have entered directly into general and strategic management positions at the department or corporate levels. Others, with more targeted interests, such as marketing, finance, or information technology, seek out positions in those functional departments." Regardless of the portal, he believes that they can all be contenders for senior management positions.

The morphing MBA job market makes sense, as hospitals and other health care providers, both for-profit and non-profit, strive to cut costs while still giving good patient care. For a snapshot of the growing cost equation, consider this: health care costs have increased an average 2.5 percent more than the U.S. gross domestic product since 1970, according to a federal report published last August.

Both pharmaceutical firms and health care providers, including hospitals, are hiring an increasing number of MBAs, according to a white paper by MBA Focus, a Dublin, Ohio, consulting firm. Author Greg Ruf writes that "new firms are entering the MBA talent sweepstakes as they begin to recruit both new and experienced MBAs to their management." Until recently, MBA graduates, especially those from top-tier business schools, were snapped up by investment banks and consulting firms, but that is changing, Ruf noted.

Is he correct? A March 26 search of online employment database Monster using key word "MBA" in health care sectors pulled up more than 5,000 current job openings.

Like other industry insiders, Ruf also has noticed signs of a MBA shortage beginning to develop in some market segments. Pair that factor with the changing demands of many "millennial generation" MBA graduates who seek "both financial reward and personal lifestyle gratification from their jobs, and the competition becomes even more intense," Ruf added.

He contends that millennial-generation students, who range in age from 18 to 29, tend to be full-time MBA students, while part-time MBA students typically are already employed, and returning for more schooling to gain a strategic advantage or switch fields, according to the MBA Focus white paper, "New directions in MBA recruiting." People enrolled in executive MBA programs usually have an average seven years with their employer, and are working in a full-time management position.

Health care preference

"I definitely see a health care preference among our MBA students. Many of the MBA students who want to work in this environment are driven by altruistic reasons, rather than money -- they want to help society. They have specific things they want to accomplish along those lines," explained Guy Groff, director of the W. P. Carey School's Career Management Center.

The school, which graduates more than 1,000 MBAs annually, offers among its platforms two MBA/health options: an MBA with a specialization in health care and a concurrent degree MBA/MHSM (Master in Health Sector Management). The Master in Health Sector Management is also offered as a stand-alone degree through the W. P. Carey School of Business.

"The possibilities for management in health care are endless -- there are so many directions you can go with the training. Hospital, pharmaceuticals/biotechnology, insurance, consulting, just to name a few," said Jennifer Ottolino, a graduate student at the W. P. Carey School. Ottolino opted for the school’s concurrent degree program -- an MBA and a Master in Health Services Management -- which she said costs "less than most single-degree business programs around the country."

Marjorie Baldwin, Ph.D., who heads W. P. Carey’s School of Health Management and Policy, recently attended a conference where discussion centered on the growing need for health managers over the next 10 years. "There are 75 or so accredited programs in health management, and they produce nowhere near the number" of professionals required over the next decade, Baldwin said. "In our last alumni survey, we asked graduates about their job search: 100 percent of respondents told us they found jobs within three months. And right now, we’ve got more internships than students to fill them."

More hospital recruiters are showing up these days at the career fairs sponsored by Baruch College, part of the City University of New York, according to Tracy Handler, director of the school's graduate career management center. "They're becoming regular attendees, and they're targeting our graduates for finance and accounting positions at their facilities," she said.

"Given what is happening on Wall Street, health care positions are becoming more attractive to students. They also want the work/life balance available in that work environment that they won't get working on the street," Handler continued.

Jason Bryant isn't sure what his "end goal" is, but when he decided to go back to school for a graduate degree, he settled on the MBA program at the University of Tampa in Florida. He plans to graduate in May 2009.

Bryant, 30, is a product line specialist for the west Florida division of HCA, the Hospital Corporation of America. He works with dozens of HCA's priciest orthopedic surgeons, making sure they get what they need to (a remodeled operating room, another surgical technician, an MRI machine) in return for adhering to his exacting profit-margin guidelines.

"Right now, I'm a little unique, because of where I work, between the supply chain and hospital administration. It's a little bit of both worlds. With an MBA, I can pursue any health care interest -- I don't know where yet -- so this is a way to hedge my bets and guarantee more opportunities," Bryant said.

Bottom Line:

•Health care accounts for 16 percent of the U.S. economy. In 2000, as a nation, we spent $4,790 per person on health care. By 2006, that number had grown to $6,697 per person.

•The W. P. Carey School of Business, which graduates more than 1,000 MBAs annually, offers among its platforms two MBA/health options: an MBA with a specialization in health care, and a concurrent degree MBA/MHSM (Master in Health Sector Management). The Master in Health Sector Management is also offered as a stand-alone degree. The W. P. Carey MHSM is the only accredited program in health management in Arizona.

•A March 26 search of online employment database Monster.com using key word "MBA" in health care sectors pulled up more than 5,000 current job openings.

Video 2 about lack of health insurance to the common man in USA

2009-08-05T23:19:00.008-04:00

Universal, Single payer, not for profit healthcare for all in America: Video 1

2009-08-05T23:19:00.007-04:00

Taiwan implemented Medicare recently after consulting U.S. experts!

2009-08-05T22:45:00.003-04:00

Another pro Healthcare Reform ad

2009-08-05T22:43:00.003-04:00

Ad against Republicans preventing Healthcare Reform

2009-08-05T22:41:00.002-04:00

Another Health Insurance reform ad

2009-08-05T22:36:00.002-04:00