An excellent story appeared yesterday on NPR that talked about the Federal Employees Health Benefits Program or FEHBP – the health insurance program that insures 8 million federal workers, retirees and their families, and members of Congress. Below is the story of a 13-year old daughter of a federal employee who feels blessed to have the FEHBP coverage to pay for the costs of managing her Type 1 diabetes. Do you think other insurance programs in the country should model themselves after FEHBP?

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the president, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Dorsey and others who are covered under FEHBP do report high levels of satisfaction, but it’s not some kind of super insurance. It’s pretty much like most insurance people get through their jobs. Federal workers, too, sometimes complain about the rising costs of their premiums and co-payments and about the hassles of getting care.

The Option To Choose

Toni was five years old when she was first diagnosed with diabetes — as long as she can remember. “At five, I really didn’t know what was going on, but I remember having my mother and my grandfather holding me down to give me shots and prick my fingers. And I was scared, I was confused, and it wasn’t a good time.”

In those early, stressful days of her daughter’s illness, Rhonda belonged to a traditional HMO through FEHBP. She’d take Toni to see an endocrinologist, an eye doctor and one specialist after another. “I’d always have to get a referral. And sometimes I would forget and I’d get to the doctor’s office and it would be a mess. And so I’d be very apologetic and we’d have to call the pediatrician’s office, and it just was a waste of time in my opinion.”

There were limits, too, on the supplies she needed to manage Toni’s diabetes. Sometimes a prescription refill for needles or testing strips would be denied.

So Rhonda switched insurance companies. Her new plan allows her to keep taking her daughter back to the specialists who know her best. “I have the standard plan which means that I pay a little bit more up front,” she explains. “My deductible is a little bit higher, but I don’t have to deal with the referrals. I can go to any doctor.”

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Across the nation, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up 7 percent. The year before, the annual premium increase was just 2.1 percent.

Toni’s Life Depends On It

For Dorsey, an information specialist at the Nuclear Regulatory Commission, her insurance through FEHBP has been central to keeping Toni healthy. “In order to live a healthy life with Type 1 diabetes or any kind of chronic illness,” she says, “it’s so important to have good insurance. And I tell Toni all the time how blessed we are because we’ve met a lot of people who don’t have insurance at all.”

Still, even with good insurance, it’s expensive to manage diabetes. Toni pricks her calloused fingertips several times a day to check her blood sugar levels. Rhonda pays a little more than $200 a month for supplies.

Toni wears an insulin pump — it’s the size of a cell phone and it’s pink. “It had to be pink,” Toni says with a laugh. Adds her mother, “Pink is definitely her style.” The first pump cost $5,000. Insurance paid all but $500.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

Toni listens to her mother and adds, “I do feel very grateful for all that I have, because that could be me.”

Source: NPR, by Joseph Shapiro

For those without health insurance or poor health coverage, there is medical tourism (as well as domestic medical tourism) to help them afford the costs of major medical care. Read more about these on Healthbase.

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Some people have gastric bypass surgery and shed 100 pounds or more. What can this surgery do for you?

To answer this question, you will first need to know what gastric bypass surgery is and how it helps you lose weight.

A gastric bypass surgery also known as Roux en-Y surgery is a medical procedure that reduces the size of your stomach causing you to feel full when you have eaten only a small portion. What your surgeon will essentially do is divide your stomach into two sections – a small upper one and a much larger remnant one using surgical staples (which is why this procedure is also known as stomach stapling). The small top pouch is the one that will hold your food. Your surgeon will also re-arrange your small intestine such that both the stomach pouches remain connected to the intestines.

The reduction in the functional volume of your stomach reduces your food intake. Not only that, the re-arrangement of the small intestine causes food to by-pass the first part of the small intestine resulting in reduced calorie absorption. Both these factors help you lose weight.

But is gastric bypass surgery for everyone who needs to lose weight?

That’s a personal choice or your doctor may prescribe it for you. Generally, it is considered in only those individuals who have tried hard but failed to achieve weight loss through exercise and diet.

Obesity, which is a complex disease, leads to other diseases. Morbid obesity or the accumulation of too much body fat increases a person’s risk for developing other health problems or co-morbidities such as heart diseases, diabetes, etc.

But how much fat is too much fat?

That’s calculated by your body mass index or BMI which is a measure of your weight in relation to your height. In simple words, it tells you how much you should normally weigh for your height and if you exceed that normal weight then you are medically considered overweight. Reducing your weight and therefore, your BMI, helps you control the risk of developing obesity related health problems. (Use the BMI calculator to calculate your BMI.)

Like any other surgery there are risks associated with gastric bypass surgery as well. Some of the risks include gastritis (which is an inflammation of the stomach lining), development of gallstones (caused by significant weight loss in a short time), nausea, vomiting, bleeding, infections, and nutritional deficiency (which can be avoided through nutritional supplements). So, when deciding to have the surgery you should carefully weigh the risks associated with it and the problems that it can solve for you.

Variations of gastric bypass surgery are gastric bypass, Roux en-Y proximal; gastric bypass, Roux en-Y distal; and loop gastric bypass or mini-gastric bypass. Gastric bypass surgery is not the only bariatric surgery available for treating morbid obesity. Some people also consider gastric lap-band as an option.

The cost can be a major deciding factor when considering the surgery. Depending upon your specific medical conditions and insurance terms, your health insurance carrier may or may not cover the costs.

The high cost of healthcare has led some Americans to seek treatment in countries like India, Thailand, Singapore, Mexico and Turkey. This practice of going abroad, which is termed as medical tourism or medical travel or health tourism, is a way of getting low cost high quality medical care. But before you decide to outsource your health care it’s extremely important that you do your homework properly – research the facilities, the surgeons, compare the cost and quality offered by different hospitals, talk to people who have had their surgery overseas, etc.

You can learn more about the growing trend of medical tourism, gastric bypass surgery and other medical and dental procedures by logging on to http://www.healthbase.com.

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Eat Smart

By Ms Melissa Aiyathurai-Johnston
Dietitian, Raffles Hospital

Brought to you by Healthbase


Food, food, glorious food! Food makes up a big part of our life. Besides providing nutritional benefits, food is also a source of enjoyment, an adventure and it tastes great!

Despite huge and beneficial gains in knowledge about nutrition over recent years, healthy eating has become harder because of the way we live and eat today. There is less reliance on home cooked meals and if we are not mindful, our meals may not be necessarily healthy. They may not be complete (e.g. not being served with enough vegetables) or the portion sizes may be too large.

In addition, the modern diet is usually overloaded with calories for energy compared to the amount we expend, has too much fat (especially saturated fat), sugar and salt and lacking in fruits, vegetables, fibre and dairy products.

This state of “over nutrition” has seen an alarming rise in the incidence of chronic lifestyle diseases. Today 1 out of 3 Singaporeans are overweight or obese which sets the scene for other conditions such as diabetes and heart disease. Excessive fat or salt and the lack of fibre have also been linked with an increase risk of certain cancers (e.g. breast, bowel, stomach), diabetes, stroke, hypertension and osteoporosis to name a few.

There is no secret to healthy eating. You just need to “eat smart”!

Enjoy a wide variety of foods
Add the grains and legumes
Trim the fat

Shake the habit – reduce your salt intake
Munch those fruits and vegetables
Alcohol – enjoy in moderation
Reduce your sugar intake
Track your weight

Enjoy a wide variety of foods
Variety is the spice of life! Everyday your body needs nutrients and other healthful substances (such as antioxidants) that only a wide variety of foods can provide. Most foods and beverages are made up of more than one nutrient, however no one food or food category has them all.

Add grains and legumes
These low fat foods should make up a large proportion of your meals. This group including bread, cereals, rice, pasta and other foods made from grains provides you with carbohydrate (your body’s fuel), B vitamins, fibre and a number of minerals. Legumes (e.g. peas, beans and lentils) provide you with good amounts of protein (important for vegetarians), B vitamins and fibre.

Having more soluble fibre in your diet, such as the type found in legumes will help to lower your cholesterol. The slow digesting carbohydrate they contain will also help those trying to control their weight or diabetics with their blood sugar control.

Trim the fat
Reducing your fat intake will lower your risk of becoming overweight which reduces your chance of certain conditions such as diabetes, heart disease, hypertension and certain cancers. Reducing your saturated fat intake will also go a long way to help keep your cholesterol in check.

Removing the skin from poultry and limit your intake of fatty meat such as pork belly, luncheon meat. When dining away from home choose more soup based dishes which are low in fat and limit those dishes made with coconut milk.

Shake the habit – reduce your salt intake
Too much salt has been linked to the development of high blood pressure or hypertension. The average diet contains more sodium than actually required.

One way to reduce your sodium intake is by tasting your food before adding salt. Also limit or avoid high sodium condiments such as soy sauce, oyster sauce, tomato ketchup. Opt for herbs, spices, chili or lime juice to add flavour instead.

Munch those fruit and vegetables
Besides being an excellent source of fibre, this low calorie, nutrient dense group provides you with essential vitamins and minerals, antioxidants, and phytochemicals that may not be present in other groups of food. Studies have shown that those people with a high intake of fruits and vegetables have a low rate of heart disease and cancer. Aim for 2 servings of fruit and vegetables daily.

Alcohol – enjoy in moderation
A moderate to heavy intake of alcohol has been associated with high blood pressure and certain cancers. An excessive intake can also lead to weight gain as gram for gram alcohol has almost twice the calories of carbohydrate or protein.

A safe intake would be no more than 2 standard drinks a day for women and no more than 4 for men with 2 alcohol free days per week.

Reduce the sugar intake
Food high in sugar tend to be “empty calories” as they have no essential fibre, vitamins or minerals and can sometimes displace more nutritious food. Most foods high in sugar also tend to also be high in fat, which if taken in excess can lead to weight gain. It is best to enjoy these foods in moderation.

Track your weight
A balance between the right food and regular exercise will ensure that your weight is healthy. Choosing low fat meals with ample carbohydrates, vegetables, fruit and protein will help you lose excessive weight, if you need to and help you to stay slim if you do not.

Be careful of fad diets or diets that offer fast weight loss as they more often do not change your eating habits and are nutritionally unbalanced. Once you go off them, the weight tends to come back straight away.

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