Cialis Effectively Treats ED

Erectile dysfunction (ED) is a common complaint in men, particularly as they age. Millions of men of all ages suffer from the condition on a regular basis. Specific medical conditions and stress can cause ED. Fortunately, there are treatments that help men confidently engage in sexual activity again. One of the most effective is Cialis. There are specific steps you can take to improve the drug's usefulness.

Seek Professional Help

It is a good idea to get a doctor to review your medical record before deciding to take any ED drug. Men who have heart problems or take nitrates are typically warned to avoid this medication. Consult your doctor as soon as you begin experiencing ED symptoms. The sooner you can begin treating ED, the better chance you have of fully recovering from the condition.

Other ED Medications

You may have also considered taking Levitra or Viagra. These are the other two leading drugs marketed for ED treatment. Generally speaking, all ED drugs work the same way. They allow blood flow to enter the penis so that men can achieve and maintain an erection after being sexually stimulated. A hard erection is the only way to obtain successful sexual intercourse.

Why Cialis is More Effective

This particular ED treatment stands out because it has a 36-hour effective period. For this reason, you do not need to take the medication daily. And you can still achieve satisfying erections during that time period. Because of its extended use period, men can be more spontaneous rather than having to plan their intimate encounters.

ED Treatment and Prevention

If you experience ED symptoms, it is important that you learn what is causing your ED. Your doctor can help identify medical problems like high or low blood pressure, heart conditions, or diabetes. But your lifestyle may also be contributing to your ED. Consuming too much alcohol or using illicit drugs can lead to your impotence. So can stress and depression. While ED drugs can help on a short-term basis, you really need to figure out what is causing your condition and address those issues as well.
Cialis can help with your ED while you work to regain a healthy lifestyle. Watch your weight, eat right, and exercise regularly to reduce stress and improve your overall health. Taking these steps will improve the effectiveness of Cialis to treat erectile dysfunction so you can have satisfying sexual encounters.

Levitra and the Emotional Effects of Erectile Dysfunction

Many people think about the effect of erectile dysfunction on a relationship or marriage and don't stop to consider the emotional effects to the man suffering from this condition. While the treatment for erectile dysfunction might be easy, this doesn't erase the psychological distress caused by erectile dysfunction. Even though most men will experience erectile dysfunction at some point in life, it is still an embarrassing and sensitive topic. If it doesn't go away after one occurrence, anxiety, guilt, depression, frustration, and embarrassment can all be felt.

Although an erection is a physical process, there are many emotional factors that lead to its occurrence. If you do not address these factors, the problem may continue to return. Your best bet is to treat the entire problem. Levitra does a great job of addressing the physical problem of erectile dysfunction, so that you can focus on the emotional.

Many times erectile dysfunction goes untreated because the man is too embarrassed to go to the doctor. However, treatment is important because erectile dysfunction may be a symptom of a bigger problem. Although it is natural to feel embarrassed, ten percent of men older than 40, and forty percent of men older than 50 have experienced erectile dysfunction - so you are certainly not alone. The older one becomes, the more likely you are to experience erectile dysfunction, so even if you think you are "safe" odds are it will happen to you as well. Levitra is taken in pill form, so you could potentially take it any time anywhere, without other people knowing.

Another common emotion felt with erectile dysfunction is depression. This can be a complicated relationship - erectile dysfunction causes depression in some cases, and in others, erectile dysfunction is caused by the depression. Nonetheless, a real connection exists, and this has been backed by research on hormones. Many men do not understand how easy erectile dysfunction is treated and, mixed with the failure to seek treatment, are faced with more emotional turmoil than is necessary. Levitra is highly effective at treating erectile dysfunction, and if you are depressed because of your condition, this treatment can be a tool to overcome the depression.

Emotional discomfort can be immobilizing. However, with the medical advances available today, including Levitra, you do not need to suffer. While everyone can admit that erectile dysfunction is upsetting, it is easily treated and doesn't have to be a big deal. Seek treatment today and improve the quality of your life!

Government Responsibility for the Health of Its Citizens

In a country such as Indonesia with a population of approximately 250 million people with the level of the developing economy, making health care quality is not something that cheap stuff, because so many of the costs required to maintain the health of a citizen. For premises that the government issued a policy that every citizen is guaranteed health by removing the health budget 20% the cost of annual expenditure.

Let us suppose that we calculate the Indonesian State costs of 800 tryliun 1 year multiplied by 20% for health care costs is about a 160 tryliun only for health care costs, should a cost of registration is no longer supposed to be found in infants who are malnourished or other vitamin deficiencies, but not optimal because the cost is used and the amount of corruption in Indonesia has caused many infant found extreme malnutrition and other diseases such as polio and cataract, where government responsibility that has been chosen by its citizens in a democracy.

People's Health: Amanah Constitution

Health is a fundamental right which is only fitting to be the obligation of governments, both national and local. In the amendment of article 45 Constitution 28H Paragraph (1) stated, "Every person has the right to live prosperous mentally and physically, residing and get a good living environment and healthy and are entitled to health care." Furthermore, in Article 34 paragraph (3) 4th amendment declared "the state is responsible for the provision of health care facilities and public service facilities they deserve".

In addition, the government of Indonesia is one of the parties (state parties) stating its commitment to the international community to bind itself in the international covenants which regulate issues of economic, social, and cultural (ESC) or the International Covenant on Economic, Social and Cultural Rights ( ICESCR). Covenant has been ratified through Law no. 11/2005 on 28 October 2005. In Article 12 of the covenant was expressly stipulated that "States Parties to the present Covenant recognize the right of everyone to enjoy the highest attainable standard of physical and mental health."

To realize the ideal conditions in the field of health care, the agenda is an urgent thing to do is:

1. In the short term we must continue to advocate (defense) rights in the health field. Problems and root causes of health services should be the themes of talks / discussions with residents in these communities. These discussions should formulate an agenda that contains the tabulation problem, the map problem, map the parties that have contributed to the health care problem-solvers. The parties involved, such as village heads, heads Health Center, Public Health Service or a member of Parliament could be invited attend the discussions. In addition to providing information as a resource, their presence should also be used to convey the pressure / demands of the problems that have been inventoried.

2. In the long run citizens must actively exert regulation health sector, which still marginalize the interests of society at large, especially the poor. For example, regulations on health budgets, service standards, the amount of levy health centers and hospitals, regulation of health services for poor households, such as GAKIN, ASKESKIN and SKTM to be easily obtained by the poor.

State - in this case the government, it must be constantly guarded and reminded residents to take care of his responsibility. By seeding the seeds of critical awareness at community level, collaborative efforts with other stakeholders - including governments, the presence of accessible health services and quality is a necessity.

Disaster Recovery Solutions With Call Center Service

No one is ever truly prepared for an emergency. We can try and envision the worst case scenario and plan a course of action to counteract the emergency. However, reacting to an emergency always carries an element of unpredictability. It is in the event of an emergency that individuals and companies are truly tested as to their commitment and resourcefulness. Emergencies, whether in the form of disasters or business mishaps, can threaten any company.

Therefore, there is an entire sub-industry in call center service that is created specifically to respond to callers in crisis. What types of emergencies might merit disaster recovery services? Fires, floods, hurricanes, earthquakes and power outages are just some examples. Not only can these events have a devastating effect on your operation, but in times of crisis there is usually an overflow of phone traffic.

This is why today's answering service business offers many conveniences exclusively for emergency events. Some of these call center outsourcing companies offer backup power and other recovery initiatives to ensure for uninterrupted service on behalf of clients. They may also offer incentives like natural gas/propane electric generators for power outages, redundant and satellite phone lines and emergency facilities on standby.

The advantages of emergency call center outsourcing are indeed great. If your office were closed due to inclement weather or some other unforeseen event, you would no longer be able to answer in-coming calls. This would be bad enough if you were just a regular commercial business, but what if you were in some sort of health-related or emergency response business? Then the inability to take emergency calls could endanger the lives of your callers!

This emphasizes the importance of outsourcing calls to disaster recovery services. A remote receptionist service would provide excellent customer service anyway, but in the time of a disaster or unexpected major event, this is when good customer service is most crucial. Outsourcing calls during an emergency will lower your risk and perhaps even help safeguard the lives of your callers.

Remember that most telephone answering services also offer message delivery options, which deliver new messages to you by text, cell phone, email or fax. You can even choose to pre-screen your calls. Now is the best time to invest in good customer service courtesy of an answering service business. Just because an emergency situation is happening is no excuse to skimp on good customer service! For more information on finding a call answering service to work with, visit TeleMessagingUSA.com.

Health Center Staff In Lead Role Preparing Their Campuses for Pandemic Flu

It sounds like the plot of the next blockbuster movie. A third of the world's population is struck down by a deadly virus that spreads across the globe so rapidly that there is no time to develop a vaccine. Up to half of those infected - even young, healthy adults - die. But as health professionals know, this scenario is not just a flight of fancy. It could be the very real effects of the next pandemic flu outbreak, particularly if H5N1 (also known as highly pathogenic avian flu) is the virus in question, and it is this knowledge that is pushing not just federal and state government but organizations and businesses throughout the world to develop a strategy to tackle it.

Within colleges and universities, the burden of pandemic flu planning is likely to fall upon many student health directors, even at institutions with environmental health and safety departments. John Covely, a consultant on pandemic flu planning and the co-author of the University of North Carolina at Chapel Hill's pandemic plan, explains why this is so.

"Traditionally, emergency planning originates from public safety, or environment health and safety, but a communicable disease poses the biggest threat to students in group quarters. Thus, student health directors are often leading the emergency planning effort for the whole university, because the entire plan - not just the student health component - could be the difference in life or death for their students."

The importance of having a campus-wide plan that is ready - not just in the preliminary stages - when the pandemic strikes is all the more clear when you consider that, unlike seasonal flu, H5N1 has an increased risk for the typical student demographic of young, healthy adults. The startlingly high mortality rate of up to 60 percent is partly due to a protein, also found in the strain of virus responsible for the 1918 pandemic flu outbreak, which causes a response in a healthy immune system known as a "cytokine storm", often leading to respiratory failure and death.

Planning for such a massive and yet unpredictable event may seem a formidable task, but Dr. Anita Barkin, chair of the American College Health Association's pandemic planning committee, counsels that those universities and colleges that have yet to formulate a pandemic plan shouldn't feel overwhelmed by the work that lies before them. "Pandemic planning is about good emergency preparedness. The things we do to prepare for any emergency are the things we would do to prepare for pandemic flu," she explains.

Although the tragic Virginia Tech shootings this spring were a different kind of emergency, the issues are similar to the issues faced in the event of a pandemic flu outbreak. Coordinating resources, communicating with everyone on campus and deciding at what stage classes should be called off are questions that have to be answered in most emergency situations. Take your pandemic planning one step at a time, advises Barkin.

"The first step is to find out whether there is an existing emergency plan on campus," she says. "If there is, who is in charge of it? Health providers on campus should then take charge and begin to formulate the plan."

There are many unknown factors, but build the framework of the plan first with the elements you can be sure of. Form a committee with all key areas represented, including executive leadership. ACHA's Guidelines for Pandemic Planning provides a list as an example that may help you collate this. Identify the functions that will be critical in the case of a pandemic and the personnel on campus responsible for each of these, making sure there are enough people representing each function that should some become sick, the plan is not compromised. Identify decision makers, a chain of command, and what channels of communication are to be used. Finally, decide on the role of student health services. Many campuses will have the student health director as the key decision maker in the event of a pandemic, but for some it will be more appropriate for the student health director to have an advisory role instead. In any case, college health professionals will be crucial to the success of every plan.

The biggest question that is central to every campus-wide pandemic plan: when is the right time to send students home? Covely warns that universities cannot necessarily wait for cues from state public health departments before they make their decisions. "The university has to have its own in-depth criteria in advance of a pandemic, and the student health director should be very involved in developing those criteria."

Barkin suggests looking back to the 1918 influenza epidemic for context.

"In 1918, the virus spread across the country in three to four weeks. If you think about the fact that the virus traveled from coast to coast in that short a time when the primary means of long-distance transport was the train, and then you think about how much more quickly we can travel today by plane, that timeline is going to be compressed significantly."

In other words, don't wait too long to send your students home. Nor should your trigger for this decision rely on the geographical proximity of the virus to your campus alone. Covely explains:

"Geographical proximity is not definitive enough in this age when in a single day, there are 50,000 passenger flights throughout the world," he says. "Because New York City and Hong Kong have major international airports, epidemiologically, New York City is actually closer to Hong Kong than it is to Buffalo, so waiting to suspend classes until a confirmed case gets to your region, or within 500 miles, may be too late."

The factors that will determine how early you make the call to send students home will center on the composition of your student population. If your students are mostly from in-state, they will probably be traveling home by car and so you can wait slightly longer before canceling classes and closing the campus down. If many students live a long way away and are going to need to use mass transportation, you may have to act more quickly or risk being swamped with very ill students at a time when the local hospitals will not have the resources to help.

There are three main elements that will shape the logistics and the scale of your plan, and help you figure out the best trigger to send students home. Remember that, as Barkin comments, "The longer you wait, the higher the rate of infection, the less chance of being able to get students home and the less likely you can manage the burden of disease."

These factors are as follows:

Student demographics, particularly the number of students who live on campus and the number of non-local students who are likely to be dependent on care.

The size of your staff (taking into account that up to 50 percent may be sick at one time).
Your ability to stockpile enough basic supplies, including medications, as well as personal protective equipment such as respirators.

This is where things start to get more complicated, however. Most student health services can't afford to stockpile many medical supplies. "ACHA is running a survey on pandemic planning," reveals Barkin. "Of the schools that have responded, most have not stockpiled, or if they have, it's not a lot." This could clearly prove disastrous, and for many colleges is a manifestation of what Covely cites as one of the biggest challenges of pandemic planning for some universities: "getting buy-in from the executive leadership." Pandemic planning is by no means a cost-free exercise.

One tip if you are facing resistance from campus decision-makers over spending money on pandemic planning is to emphasize the fact that once you've formulated a response to a possible pandemic, you will have a robust emergency response strategy that can be adapted to fit virtually any emergency, whether it's evacuation in the event of wildfires, such as Pepperdine University faced recently, a terrorist threat, or an "active shooter". Investment in, say, developing a Web site with emergency information and updates can be a public relations bonus and a reliable resource. Villanova University's plan includes broadcasting SMS text messages and e-mails and using an emergency Web page for mass communication.

When you do know the scope of your resources, both human and financial, you can continue to flesh out your plan. Excellent resources can be found on ACHA's Web site: http://www.acha.org and http://www.pandemicflu.gov. A tip from the experts: be wary of developing your plan in a vacuum. "I know of a school that didn't know their gymnasium was being considered as a point of vaccination until they happened to find out in the course of an outreach program," Barkin relates. "The local health department hadn't informed them." This is very obviously a benefit of starting a dialogue with your local health services: you find out what they have planned and you can also coordinate your plans to add value and decrease the number of unknown factors.

Dr. Mary McGonigle, director of the student health center at Villanova University, says that their dialogue with their local health department led to Villanova being assessed and labeled a "push" site, a location that is self-sufficient in this type of emergency. She explains:

"In the event of a pandemic, we'd go and pick up supplies from the county and then administer medicine to our Villanova community. That includes students, faculty and their families."

Help from the county is a financial boon but being self-sufficient and staying local also lowers the risk of spreading the virus so rapidly. The dialogue helps your local health services too. If your local hospitals are likely to have a shortage of beds, they may want to use college dorms for surge capacity at the peak of a pandemic. In return, they may be able to offer you some resources, although research suggests that most hospitals have not had the budget to be able to stockpile effectively either.

Once you have your plan together, it's important not just to file it away and forget about it. "Planning for a pandemic is very much a work in progress, but it is often hard to keep up the interest in reviewing and updating plans, especially when H5N1 activity drops out of the news," explains Covely. Tabletop exercises are one way to test the effectiveness of a plan and a good way to maintain interest. Covely specializes in facilitating these tabletops and finds that they can significantly increase staff's buy-in as well as providing useful discussion points.

"Used before the planning begins, tabletops provide a way of educating employees and getting them interested in developing continuity of operations plans," he says. "They are excellent for post planning too, in order to test the plans. I am always amazed at the creative analysis and insight that comes from a tabletop."

The ongoing and fluid nature of pandemic planning is very much evident in some of the complex and thorny issues that have no definitive answer. These may need to be revisited and rethought as scientific discoveries are made, as you approach a pandemic, and if your college's resources change. One such issue is the availability of expensive antivirals. The federal government has announced that it is stockpiling them and coming up with a strategy for distribution, which might seem to take some of the financial pressure off student health services. Barkin however has a caveat. "I'm concerned that stockpiles would not be distributed in enough of a timely fashion to make an impact on the community. Katrina is a situation that has to come to mind."

Even if you did manage to persuade campus decision-makers to invest budget in stockpiling antivirals, a potentially challenging feat, there's a chance that they would be ineffective by the time a pandemic occurs, as overuse can cause the emergence of a resistant strain. Barkin explains that infectious disease experts are talking about using a treatment cocktail - Tamiflu plus one or two other agents - to protect against the emergence of resistant strains, but this would be prohibitively expensive for the average college health center.

Another ethical dilemma surrounding pandemic planning concerns who should get prepandemic vaccines. Scientists are developing vaccines based on the strain of avian flu that has been circulating in Asia, hoping that the vaccine would be enough of a match to combat the illness until a proper vaccine could be developed six months after the pandemic's emergence. But supplies of this prepandemic vaccine will be limited.

"Some of the conversations around who should get these prepandemic vaccines are very complex," says Barkin. "Should it be health care workers that get it, or public safety workers such as firemen? Should it be government officials, or the very young and elderly?" Recently, the federal government has announced a three-tiered approach to vaccination that it has developed in consultation with public focus groups and ethicists that places health care workers in the second tier. Whether your health center staff will receive the vaccine, whether it will be in a timely fashion, and how effective it will actually be, are all factors that will affect your pandemic plan greatly - and demonstrate how much of your planning has to leave room for the unknown.

One thing that is beyond question is the importance of student health services acting now. Formulating a pandemic plan may be a slow and ponderous task, but there's one vital aspect that will slow the spread of a pandemic and can be tackled by your department immediately without getting tangled in red tape and endless meetings. Barkin elaborates:

"Every single student health service needs to be involved in educational outreach efforts to distribute information on the role of flu vaccinations, cough etiquette, when to come to work and when to stay at home if you are ill and the importance of creating a personal preparedness plan in the event of a pandemic."

This public health education can be a collaborative effort with human resources and residence life staff. Covely agrees and even suggests extending the scope beyond campus boundaries. "It's part of being a good and responsible neighbor to the community, and it has tremendous public relations benefits to the university," he says.

The collaboration required in pandemic planning can build bridges, but be prepared for it also to be particularly challenging. McGonigle relates:

"At Villanova, we're still in the stages of planning. We've done a lot. But I would say the most difficult part is trying to connect and communicate with all the different departments on campus and plan for all the different scenarios."

Indeed, planning for all contingencies - not just the obvious problems of effectively treating the sick and minimizing the mortality rate, but also coping with disruptions to services and shortages of supplies caused by huge absenteeism and the ensuing breakdown in the transportation system, and questions such as whether to pay staff if the campus is shut down - has caused planning at many colleges and universities to take much longer than anticipated.

Pandemic planning is also dogged by a sense of unreality: could something this vast really happen? (The answer, as every health professional knows, is "yes", and is a question of when and not if.) Media coverage of pandemic flu is patchy and focuses on sensational stories rather than the need for personal emergency preparedness. Because it's not an issue in the forefront of the public's mind, it's sometimes hard to conjure up the necessary sense of urgency, particularly because there is always some issue on campus demanding more immediate attention. Barkin sympathizes, but has some sobering last words on the subject.

"Recently, the issue of pandemic flu has fallen off the radar," she says. "We've been talking about it for two years and now there are other pressing issues that have pushed it to the back burner. But the issue of pandemics is not going to go away. We've had them throughout history and if you look at the patterns, we're due for a pandemic soon. It may or may not be H5N1, and it may or may not be on the 1918 scale. What we cannot ignore, however, is the planning that's needed, because in a pandemic, health centers and heath care providers will be looked to and expected to know how to respond."

Passing On The Tradition of Service in a Think Tank

Perhaps you have traced your ancestry and discovered that you have some public servants, military generals or famous politicians in your family tree. Maybe you have some industrial capitalists in there some where as well. If you do indeed have some strong family names with a lot of history behind them, shouldn't you do the family name some honor?

Not long ago, I met someone with a strong family name who indicated to me that he wished to join a think tank. We talked about this and I indicated that it is interesting that he studies Economics, Politics and History, as his ancestry has been making a lot of it for centuries now. He also had some famous generals in that lineage. The Defense of a nation is paramount if the civilization is to continue. All these subject matters are important at any serious Think Tank. This prompted me to ask:

So tell me, what brings to a think tank at this juncture of your life experience? Are you a student, professor now? What issues do you consider important at this time? It seems a bit of World History is being made during the present period and we are living through some turbulent times, although not as turbulent as past periods, yet interesting nevertheless? Surely, the decisions made today affect the forward progression of mankind into the next period.

Since he lived in Maine, we also got to talk about his state and area and I asked; Are there local issues in ME that concern you? Lobster shell problems, dead zones, price of natural gas, weather, economics, small business, downtown revitalization, securing clean industry and tech?

What issues do you find problematic for the Northeast over all? What are your thoughts on the former Governor of MA for President? Any thoughts on the Big Dig becoming a big disaster, if needed repairs go unchecked? How about alternative energies, robotics, nano-tech, defense tech, AI, VR, etc, as you live so close to so many top Universities, Technology Centers and Business Incubators, with lots of capital ready and waiting?

Of course, he was also interested in the bigger picture too and so we talked about more national and Global issues; What do you see is the biggest problem for our nation? Do you consider us a divided nation? Do you find this to be good, bad, indifferent, or opportunity for profits in the chaos? How about transportation, education, energy, borders, water supply, currency, trade deficits, consumer debt, health care, etc.?

What issues do you see on the World Scene? Do you feel that water, weather, oil, drugs, NGOs, genocide, child slave trade, urban slums, bird flu, are issues that need addressing? What are your thoughts on Radical Elements with radical motives? Where would you change things and what would you change at the city, state, region, national or Planet level?

Everything matters at a think tank, no detail is without merit, all must be considered to prevent the unintended consequences of linear thought. Perhaps you can see this, perhaps not, but if you do and feel strongly about it, maybe its in the genes and your family tradition, thus, shouldn't you give back a little as you grow? Think on it, talk with you soon.

Call Center Services Keep New Business Start-Ups From Failing

Before diving into a start up company there are many things to consider that could otherwise cause a financial disaster in a short period of time.

Statistically, about one and every three businesses will fail within the first two years. Often times it's just a matter of poor planning or lack of funding. The bottom line is that while the money may run out the bills wont and the employees will still expect their wages. The entrepreneur should take a close look at the cause of this alarming statistic before launching into to new venture. Naturally it is important to know your industry and your competitors but it's just as important to know how to save money on the every day costs.

One commonly overlooked investment is the use of call center services, and specifically telephone answering services. These services can literally help a company to save money and make money at the same time. Here's something to consider along the journey. When hiring a new full time receptionist a company can have payroll and taxes to the tune of about two thousand dollars a month. Additionally the employer will take on the cost of benefits, health insurance, and paid holidays. Further, if she's like most people she will call out sick, run late and when the phones aren't ringing she's still on the payroll.

An answering service is usually open twenty-four hours a day and every day of the year. They never close, call in sick, or complain. More importantly, with the exception of a small monthly fee, a good service will only charge for usage. When you are only charged for usage that means you are only charged when calls are being taken on your behalf. Phone answering services usually only run about one dollar per call which means you could literally have a service take one hundred calls a month and still only spend about a twenty five dollars a week. It's not even possible to hire a part time employee for that little amount of money.

The fact is most start ups can not afford the cost of a full time receptionist, but they know they really need one because they realize that an answering machine or taking your own calls says we're a tiny company and we may not be big enough to serve your needs. Bottom line, image is very important, and we naturally tend to think the small guy is unsuccessful or not able to handle our needs. While that may not be true, perception is everything. A service creates the image of having your own live secretary and dramatically improves the overall image of the business.

A final reason to consider using call center services is time. Most new business owners are extremely busy and are either with clients, up to their neck in paper work or need to focus on a big project. Being enslaved to a telephone is not an option and it just slows the entire work day down. Let's face it, you can't carry on twenty phone conversations a day and work at the same time. Further, if you're in a business that bills it service at an hourly rate it's just not right to spend time with other clients while your current customer pays for it. Let a service do it for you and you'll save time, money and create the image of being a big successful business owner.

Higher Attrition Rates - Menacing the Growth of the Call Center Industry

While the call center industry is looking forward to the unstoppable growth, attrition rates are marring its prospects. As per the data published in the leading newspaper after a statistical research of attrition rates in call center outsourcing industry it was concluded that Australian, European and Indian call centers reported 29 percent, 24 percent and 18 percent attrition respectively. On global average it came up to 24 percent. According to research data, the attrition rate for voice-process is around 55-60 percent and 15-20 per cent for the non-voice schedules. It also predicts that there would be 1.1 million call center job requirements by the years to come whereas the shortage of around 2, 62,000 professionals dooms the call center industry this year.

As per a definition attrition attributes to the downsizing of a company in size or number. In call centres where a thumbs-up to a project takes the company a step ahead, attrition push them miles back. Other then rigorous shifts, monotony of the work, workload and physical strain or no personal life things attached to it, there are some reasons for which employees leave their call center jobs:

1) Poaching: Another big call that needs to be resolved is "Poaching". Poaching is to lure the candidate of one organization by offering bigger rewards or high salary. Poaching is a common exercise observed by almost every organization nowadays.

2) Psychological Stress: Working on weekends/holidays, the guilt of no time for spouse or family took toll on mental health of call center workers.

3) Policies at Work Place: Some of the call centers are termed as Coolie Centers by their employees. The workers join there for experience or in some need and then, flew off.

Attrition has become major threat to the boom experienced by call centres. Besides the lost efforts and wasted time, an organization suffers with monetary losses as well.

1) In case, if we calculate the post of a person in terms of expenses/salary/benefits and the profit he could have brought to the company and compare it with the time when the post was vacant and productivity was zero even the work was completed by another team members. Also, include the cost of the time taken to interview the person, the administrative time and costs to begin and stop the payroll and other company benefits, the cost of manager's time to understand and evaluate the situation to know what is pending, training costs, the cost of the impact on departmental work, the cost of knowledge/skills/ information that company entrusted in you and so on amount enough to weigh down a company under financial crunch.

2) The cost of advertisements like-job portals, in-house recruiters, referrals and internet posts range high to a call centre.

3) New hiring costs higher to a company than the previous one.

It is clear that the costs related to attrition are threat to the financial sanctity and credibility of any organization. Some of the dangers are directly associated with the organizations some are not. However, all of them are real and HR should take desperate measures to attend the causes whatever they are.

To estimate, the cost of attrition to a company, the thumb rule mentioned below stands credible. Though, it depends on the category of the staff.

The cost of attrition = (Total staff x attrition rate in percentage) x (annual salary x 80 percent)

Searching For Affordable Outbound Call Center Services

Now a day the lot of technologies made the entire world as a corporate sector. Lot of companies is having that professional outlook and displays the same to the customers.The interaction which the customers have with the company is usually over the phone and having a professional call answering service is a must in today competitive landscape.

The first step is to identify the needs that you have for the telephone service. You will need to answer those questions before looking for the perfect business service. Next research the live answering service companies as well as other phone call answering companies and find out what kind of services do they offer? There are a large number of companies that offer these services. Check the options that are available like single toll free number, call forwarding and also how they handle messages.

Check whether the company has a multi lingual service? Most of the companies will agree to it for free or by paying up for a small fee. That will help you determine how effective the service operators are. Next ask the company for references so that you can check the services that they offer to other companies. Also if you want specialty services like physician service then check if the company offers them or not? Check if the company will sign a non disclosure agreement with you. This is essential as you do not want to have your customers details in wrong hands.Select the service for a monthly fee or based on the number of calls that are answered.

The type of clients you have is similar to the type of business that you have. As previously mentioned, lawyers and repair workers should be available at just about anytime of the day. Crime and roof leafs do not have a set schedule. Since you do have a life, an service could not only benefit your business, but your personal life as well.

Contractors and medical professionals are just a few of the many individuals who can benefit from an service. Other business professionals that can benefit from using an answering service may include, but are not limited to, attorneys, insurance agents, home health care providers,and government workers. If you are currently employed as one of those individuals you are encouraged to increase your profits and customer satisfaction by using a professional answering service. Ultimately,finding a good answering service will depend on the exact services you want,and the price you are willing to pay. Be prepared to go through a number of services to find the perfect fit for your purposes.

What to Expect at a Reproductive Health Center

A reproductive health center is a facility that is designed to help individuals and couples experiencing infertility find relief. This may be a troubling condition for many experiencing it, making counseling important along with the treatment process. Many reproductive centers now offer stress relief treatments and exercises as well as counseling services along with the fertility treatments and procedures that are normally available at many clinics.

When you first seek consultation at a reproductive health center after experiencing infertility, you will likely be asked several questions regarding your health and medical history, as well as personal questions about your attempts at conception. Be open with the fertility specialist and make sure you find one with whom you feel comfortable discussing these matters. Keep in mind also that these specialists deal with these issues every day and understand patients' reluctance or hesitation to discuss personal matters.

In many cases, tests may be performed in an attempt to pinpoint the problem so that a solution may be worked out. Ask your specialist about the different tests being performed to help you understand the process. Diagnostic tests such as semen analysis, ultrasounds and cycle monitoring may be used to help determine the cause of infertility for many individuals and couples. Clinics may also investigate the possible causes of recurrent pregnancy loss if this is an issue. If the tests reveal the cause of the infertility, the specialist may recommend various treatment or procedure options and explore these options with the couple or individual.

Some of the more common fertility treatments available at many reproductive health centers include in vitro fertilization (IVF) and intrauterine insemination (IUI). In vitro fertilization involves the combination of sperm and eggs in a dish in a laboratory to create embryos, which are then transferred to the uterus where they may implant in the uterine wall and develop. Intrauterine insemination involves the direct injection of sperm into the uterus where it may fertilize the egg to create an embryo, which may then implant in the uterine lining and develop.

A variety of treatments and procedures may be available to treat various possible causes of infertility. These include endometriosis, polycystic ovarian syndrome (PCOS), among many others. Male infertility may also be treated at many clinics. To help patients through what can be a difficult time, many clinics now offer counseling or stress-relieving exercises such as yoga or fertility massage to help patients relax and manage their stress.

Know the Basics of Call Center Services

Since they appeared on the scene about fifteen years ago, call centers have become a staple in the business world. The advances in technology and information technology in particular, have enabled the call center business to expand and succeed. Call centers are offices that receive large volumes of telephone calls from customers of the companies they represent. Call centers are manned by call center agents.

The interesting thing about call centers is that they do not need to be in the country of the companies they provide the service to. In some cases it is generally more cost-effective to establish call centers in other countries. This is one reason why offshore call center services are in such demand. There are in fact different types of contact center, namely:

o Inbound call centers: These types only take calls from customers, hence the name. They were once the most common type of contact centers.
o Outbound call centers: These are generally the opposite of inbound call centers in that call center agents makes calls to customers and prospective clients seeking sales or lead generation.
o Contact centers: With this type contact with clients is not just via telephone, but also by live chat and email. Contact centers may also be responsible for handling all written correspondences for a company that is, letters and faxes.
o Blended call centers: These types have features of all the others. Blended contact centers may well be the future of call centers as many begin to offer all the services being demanded by customers.

Benefits of a Call Center

There are many benefits to using a call center. The main benefit is an increase profitability brought about by improving efficiency. There is more time for staff to perform their core functions instead of answering calls or processing applications. The fees for outsourcing to call centers is minimal compared to paying full time staff.

Services

There are a wide variety of services that call center offer: These include:

o Phone answering service
o Troubleshooting/technical support services for products
o Messaging services
o Voice Mail ordering
o Outbound Telemarketing services

InSO International Call Center offer a variety of call center services. These services take in some of those listed above but also include:

o Backend transaction processing and office services: Here we go the extra mile while providing professional services in skip tracing, payroll processing, application processing and researching and analyzing data.
o Outbound collections: At InSo we make calls to clients requesting payment on your behalf or acknowledging that payment has been received.
o Customer care: InSO customer care is more than just responding to queries. We treat customers right so as to build loyalty - each customer is treated as a valued individual.

InSo also serves a wide cross section of businesses. In fact, we represent companies in the:

o Financial services sector
o Travel and hospitality industry
o Health and Supplement industry
o Technology industry
o Telecom sector
o Insurance
o eCommerce and Retail

Unlike some contact centers, InSO makes it possible for small and medium-sized companies to be able to afford their services. If you are still not sure what we can do for you and at what cost, ask for a free, no obligation quote. The benefits of leaving your call center services to InSO includes improved efficiency and ultimately, an increase in profitability.

InSO International Call Center proves that all call centers are not the same. To learn more about our services and how we can help you succeed, visit us online at http://www.inso.us. We make reaching us easy as you can also call us at 626-531-6080. Our email and chat support services shows that we want to make it easy for our clients to reach us. Take your business to the next level - let InSO Call Center take you there.

Call Center Agents Play a Key Role in the Customer Support Service

In recent years, many technological advancements and innovations in the call management industry have greatly improved the efficiency of both inbound call centers and outbound call centers. An offshoot of call centers, "contact centers," has emerged as a system of all-inclusive client interaction with the options of telephone communication, live chat, instant messaging, email and faxing.

Call center agents play a key role in the customer support service because agents are the first person of any telecommute organization, who directly interact with customers and represent their clients image. The best way to develop call center Agent into a well-rounded individual is by providing them proper training of process and call center technologies.

Advanced functions that are now commonly used in inbound call centers work to filter callers based on need and direct them to the appropriate agent. This allows for faster solutions and less caller wait time. Similar systems work inversely for outbound call centers and match the relevant agent to specific sales leads. Below is an outline of the key features of an advanced call center that can have major impacts on your companys productivity:

Predictive Dialer

Predictive Dialer is a comprehensive outbound contact center solution. The latest version offers new features designed to improve flexibility and simplify system maintenance, as well as greatly expanded security capabilities to provide increased protection of customer information during call handling.There are many types of predictive dialer on the market today - each equipped with its own unique procedure. The end result is the same - only live calls are transferred to the agent is desktop. But what happens after the live call is delivered to the agent within milliseconds of the contact saying "Hello"?

Call Tracking & Interactive Voice Response

IVR Systems have a number of uses today. In applications of all kinds, Interactive Voice Response is providing a way to save on costs, increase automation rates and increase business efficiency.When it comes to meeting the needs of today health care industry, having an automated, telephone-based program is extremely beneficial.

IVR Systems in the health care industry offer a way of automatically handling every call, as well as the ability to handle calls on the first ring, 7 days a week, 24 hours a day. Not only does this improve the experience for callers, it also saves the industry lots of time and money and expands their capabilities.

IVR Systems can be used for a number of applications within the health care industry to speed up and enhance processes once requiring staffing and manual calling. This includes payment tracking, claims processing and billing admittance and discharge records, inventory reports, to office locations and operation hours, changes of address and even routing callers to the right personnel.

Call Detail Record Reporting

Call detail record logging is the means of recording and retrieving telephony data. Call Detail Record data is essential in monitoring, analyzing and forecasting communication facility usage. The information is often gathered and processed through a call accounting software package. Communication managers utilize various reports to track network performance, misuse and abuse, employee productivity and cost allocation.

Real Time Telemetry

Telemetry (synonymous with Tele matics) is a technology that allows remote measurement and reporting of information.Although the term commonly refers to wireless data transfer mechanisms (example.. using radio or infrared systems), it also encompasses data transferred over other media, such as a telephone or computer network, optical link or other wired communications.

Maximizing Your Health Center's Performance and Making a Business Case

Successful organizations rely on systematic methods of tracking results and compiling data to effectively demonstrate what has been profitable and beneficial. Measurable results can lead to increased budgets, new resources or even a raise.

Nuesoft Xpress(TM) client Brenda Dalton, MBA, MSN, RN-C, WHNP spoke on the importance of "Making a Business Case for your Health Center" at the Mid-Atlantic College Health Association conference Oct. 22-24 in Lancaster, Pa. Her presentation highlighted the importance of maintaining a high level of business know-how in your approach to student health care services so that you can maximize your health center's performance, market your department, build and maintain relationships with the decision makers of your university and reach key goals.

"Colleges are faced with having to validate rising costs of tuition; as tuition costs increase, sometimes student health services get the lower end of the budget," said Dalton. "That's why it is so important for student health care providers to make an effort to gain the attention of those who influence or control the budget."

According to Dalton, one of the ways you can maximize your health center's performance is to automate many of the everyday functions required to run your office. For example:

* Use a computerized scheduling system

* Electronically integrate a student's demographic information with her/his medical record

* Increase accuracy with an Electronic Medical Record (EMR)

* Track immunization compliance

Dalton said that once the steps to maximize your health center's performance have been made, you should begin to market your department:

* Use student groups and organizations to tell your department's story.

* Communicate department accomplishments to public relations for inclusion in campus newsletters, web pages or other campus communication tools.

* Be a featured health writer or interviewee in the student newspaper.

But marketing may not be enough, either. Dalton stresses that a big part of being successful stems from the ability to articulate results effectively to decision makers.

With so many health care centers closing down, Dalton notes, "When I can, and as often as I can, I want to sell the value of my department. It's about survival."

Useful Information About Health Care Services

Florida has variety of health care services around the state covering all the cities and towns round the clock. These services are providing a complete range of facilities covering all the aspects and needs. All services providers are monitored and controlled by the law enforcing authorities to ensure the quality of services provided to the clients.

These kind of services can be divided into two main groups:

  • Health Care Equipment and Services
  • Pharmaceuticals, Biotechnology and Related Life Sciences
The agencies operating in Florida are also offering following different range of services in order to provide health care to their clients:
Hospitals/Clinics, Treatment and Management of Illness, Medicine/Pharmaceuticals, Clinical Laboratories, Pathology, Occupational Therapy, Speech Therapy, Medical Insurances, Housekeeping, Laundry/Linen, Food, Nurse Practitioner Services, Ambulatory Surgical Centers, Assisted Care Services, Birth Center Services, Child Health Care, Chiropractic Services, Community Behavioral Health Services, Clinical Services, Dental Services, Medical Equipments Supplies, Early Intervention Services, Family Planning, Dialysis Center Services, Hearing Services, Home Health Services, Medical Foster Care Services, Optometrist Services, Podiatry Services, School Based Services, Mental Health Services, Therapy Services and etc. And all the clients can get a huge benefit from these kind of beneficial urgent medical care services.

Other Facts:
Following are some estimated figures regarding Medical and Non-Medical agencies operating in Florida and other facts regarding services facilitating in Florida;

  • 20+ cities having 40+ Non-Medical (Private Pay) Agencies
  • 60+ cities having 1100+ Medical (Medicare/Medicaid) Agencies
  • 300+ Hospitals operating in Florida
  • Around 60,000 physicians are working in the industry
  • Around one million people are employed on health services and social services jobs.

Examining Your Office Building and Fitness Center Services They Provide

Many office building and fitness center services are focused on attracting high quality employees to a certain company. With the ability to workout and vent any stresses of the day, employees are less prone to burnout and frustration. These office building and fitness center services also allow a place for coworkers to congregate after and before work to relate in a better way when they're in the office. Here are some of the services that your employer may want to consider adding to your building.

One of the easiest ways to make health and fitness convenient for an employee is to offer office building and fitness center services. By including a simple room or rooms with gym equipment, weights, weight machines and even a small running track, an employer will give their employees the added benefit of being able to maintain their fitness levels. When these fitness levels are maintained, the employee is going to have fewer sick days, fewer mental health days, and less expenditure in terms of their health insurance. This all adds up to a business that has higher morale and happier employees that are willing to do their work well.

To make office building and fitness center services convenient, these areas should include a daycare area for any children of the employees. Some employers offer these childcare services throughout the day, but even having some childcare professionals just during the gym hours would help the employee use the facilities when it's convenient for them. Children will be able to have their own fitness classes or perhaps just a fun playtime with other employees' children. Instead of paying for high cost childcare in their own homes, the employees will be much more likely to use their employer fitness center, which increases their health benefits.

Other fun additions to the office building and fitness center services can include personal trainers, a swimming or lap pool, basketball courts, volleyball courts, and exercise classes. By giving employees a lot of options in their fitness, you increase their attendance. Not everyone likes to use weights or machines - and not everyone can use them when you have a larger group of employees. When you add more options to the fitness center, you create enough fitness to go around for everyone.

When you find an employers with office building and fitness center services, you can tell that this is someone that truly cares about you as a person - not just an employee. Employees that stay healthy in their jobs will stay with the company for longer, produce more, and be assets to the profitability of their employer. It's not just about the health of the company, but that's certainly something that adds up for the employer.

Health Center Grants From The US Government

These government grants are meant to cover all the necessary costs for setting up a Federally Qualified Health Center in any state of the country. These grants where created by law.

The act that contains specifics about these grants is the Public Health Service Act under the title of Consolidated Health Center Program. This section establishes five different kinds of health center programs each of one with different requirements and conditions. Following is the list of the different grants defined by the Public Health Service Act:

Community Health Center Program

This program helps create and maintain community health centers all across the country. These grants for specific regions or areas that need private parties (non profit or profit) to complement ones that cannot deal with all the demand on that particular place or that need to supplement on specific fields of expertise or disciplines not provided by the current government health centers.

Migrant Health Center Program

This program is meant to provide assistance for funding health centers for migrants; from normal assistance to specific needs of those who migrate from abroad or interstate. There are many coordinated by migrant populations that group up to protect themselves and through these programs, the government contributes to fund those projects that have a significant importance.

Health Care For the Homeless Program

Those who are homeless experience significant more hazards and diseases and therefore need health care and use health services often. Since they are homeless, the lack of health insurance needs to be compensated with public or private non-profit medical assistance. Health Care who specialize in assisting the homeless can obtain funds through these health care for the homeless grants programs

Public Housing Primary Care Program

There are many public housing facilities out there to protect the homeless and provide them with a roof for different periods of time. These facilities need to provide primary care services too. Public housing primary care grants programs are meant to fund these facilities and provide them with the money needed to assist those making use of public housing. Only simple medicine practice and procedures are performed in these places but nevertheless, funding is always needed.

School-Based Health Center Program

Just like public housing, schools also need primary health services covered for accidents or common diseases that can affect students that are underprivileged, need immediate assistance or don't have insurance coverage. For these situations, schools that need assistance to fund the necessary facilities and hire the staff to do the job, can obtain financing through school based health center grant programs.

Requirements For Approval

Only private, charitable, tax-exempt, non profit organizations or public entities are eligible for these government grants. However, there are also private institutions providing funds for these same purposes.
Therefore, there are funds available for almost anyone who is worried about providing health care for those who cannot afford private medical solutions.

Natural Health Center - Living Well and Learning

Find Natural Health Center(s) in the United States and Canada. At a natural health center, individuals can receive natural healing treatments and can also acquire knowledge about the various natural medicines available today. Whether you're making your initial trip to a natural health center, or you've come back to learn more about innovative healthcare remedies, you are sure to be awed by some of the ancient and latest complementary medicines offered.

For instance, a natural health center is one that promotes preventive medicine and wellness through natural healthcare. Some of the many healing arts services and products that are provided at a natural health center include naturopathic medicine, acupuncture and Oriental medicine, herbal medicine, essential oils and supplements, Bach Flower remedies, chiropractic, and massage therapy, among other related modalities.

A natural health center that offers chiropractic medicine will commonly help patients to learn about and understand the various aspects of the treatment. A normal visit to a chiropractic natural health center entails a brief summary about what chiropractic is; its philosophy, and case-taking of the patient's health history. Most chiropractic doctors (D.C.) in a natural health center will educate the patient on assorted terms including "dis-ease," and "subluxation." In addition to taking an X-ray to assist DCs in locating subluxations of the spine, patients are frequently welcomed back to the natural health center for public education classes to learn more about chiropractic medicine. Sometimes, chiropractic natural health centers offer other services like massage therapy, and natural nutrition consultations.

A natural health center that strictly provides wellness services like massage therapy, aromatherapy and esthetics is appealing to day spa goers who want to look and feel younger and healthier. Massage therapy services at a natural health center and day spa are often combined with essential oils and aromatherapy, herbal wraps and facials. Individuals who frequent natural health centers like this will often find several natural healthcare and skincare products like herbal medicine, vitamins, supplements, lotions and oils.

In an Oriental medicine natural health center, patients will learn about the various techniques and philosophies of TCM (Traditional Chinese Medicine), how acupuncture works, and may be counseled in Chinese herbal medicine nutrition. In some cases, a Doctor of Oriental Medicine may treat patients with moxibustion, cupping, Tai Chi, Tuina (Chinese medical massage), and Qi gong; among other associated methods.

Iridologists and herbalists often work closely together in a natural health center where they provide a health analysis through the study of the eye, Ph balance, and kinesiology. Clients quickly learn how certain indicators and markers on the iris may sometimes indicate health disorders and conditions. Herbal and supplemental prescriptions are often advised for therapeutic relief.

While there is a wide assortment of holistic healing and wellness clinics throughout the United States and in Canada, one can be certain that a trip to the natural health center will be both noninvasive and educational. In most cases, patients and clients who have visited a natural health center find a sense of overall wellbeing and better understanding to these sometimes misunderstood fields of integrative medicine.

If you (or someone you know) are interested in finding natural health center(s) and natural healing schools, let professional training within fast-growing industries like massage therapy, cosmetology, acupuncture, oriental medicine, Reiki, and others get you started! Explore career school programs near you.

Natural Health Center: Living Well and Learning
© Copyright 2007
The CollegeBound Network
All Rights Reserved

NOTICE: Article(s) may be republished free of charge to relevant websites, as long as Copyright and Author Resource Box are included; and ALL Hyperlinks REMAIN intact and active.

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Student Health Centers Boost Revenue By Billing Commercial Insurance Plans

With college health centers facing significant increases in the costs to provide health care services, as well as decreases in their funding sources, many health center administrators are having to think outside of the box for ways to extend budgets and maintain a high quality of care for their student patients. As a result, more college health center directors and their staffs are turning to commercial insurance plans.

"Health centers at many public institutions used to get 100 percent of their funding from the state, but times are changing," said Jennifer Lepus, director of university health services for the University of Maryland - Baltimore County.

The UM-BC student health center is one of hundreds nationally that have struggled with state budget cutbacks. Health centers at impacted schools may still receive some funding by offering student health insurance plans, but reimbursements from those plans - which are provided by a handful of companies that contract with colleges to offer exclusive group rated coverage to students - are typically not enough to support a health center budget.

"Our difficulty in offering only a group rated insurance program was that voluntary enrollment was not enough to sustain it," said Western Kentucky University's Health Services Director Libby Greaney. "So, WKU's solution has been to accept commercial insurance plans, and file those claims.

WKU began billing insurance companies in 2001, after student health fees were cut the previous year.

"If your doctors are board-certified and credentialed, they can establish themselves as primary care physicians. This enables you to see community patients who are in-network with the plans that your health center accepts. If balanced properly, you can increase your service net and your revenue streams."

According to Greaney, more and more schools are realizing the benefits of opening their health centers up to commercial plans, and taking a similar approach to WKU's.

"People are beginning to see the need. They are talking about it and addressing it," she said. "Those in college health who are resistant to the idea may be viewed as 'old school' if they do not embrace the concept."

"More and more senior vice presidents at colleges are hearing about this approach, and are giving the directive to their health centers. I would encourage health center staff to be more in the driver's seat."

But Greaney also recognizes a natural conundrum. While accepting commercial carriers can open up additional revenue streams for college health centers, it may also impact access to care. The reality is that not every student enrolls in school with insurance coverage. Students without coverage either go without care, or must pay out of pocket for medical costs that are growing more expensive each year.

With the American College Health Association and some states calling for colleges and universities to provide health care coverage to all students, some schools are offering a menu of options.

For example, Lepus and her staff at UM-BC have opted to accept both a student health plan and plans from commercial carriers.

"If the goal is for every student to have coverage, we can achieve that by offering both options," Lepus said. "The school plans are less expensive for people, but we have found that many young people today are covered by their parents' insurance plans until they turn 23 years old. That means that a large number of students have coverage through private carriers, and it seems logical that when they come in to be seen, we can bill those insurance companies."

The University of Utah at Salt Lake City is another example of a health center that has found that billing to commercial insurance carriers as well as offering a traditional student insurance plan through the university is a win-win for both students and the health center.

"By offering both options, we have a medium-sized pool of students who are required to come to us with their insurance, but we are also affordable and convenient for students with out of state insurance who will be paying out-of-network percentages or deductibles," said Tiffany Smith, office manager/patient advocate for the University of Utah at Salt Lake City's health center, which attracts about 7,000 students each year. "When we bill commercial insurance carriers, we make the process easier for our student patients, and this keeps them coming back to us in the future."

And when they come back, it means additional revenue for the health center.

Although accepting commercial insurance carriers might seem overwhelming, Greaney offers a bit of advice to other health center directors who are considering it:

"Start small, and utilize the resources that are available to you," she said. "Namely, people who have gone through this either in college health or out in the community."

Health Center Grants From The US Government

These government grants are meant to cover all the necessary costs for setting up a Federally Qualified Health Center in any state of the country. These grants where created by law.

The act that contains specifics about these grants is the Public Health Service Act under the title of Consolidated Health Center Program. This section establishes five different kinds of health center programs each of one with different requirements and conditions. Following is the list of the different grants defined by the Public Health Service Act:

Community Health Center Program

This program helps create and maintain community health centers all across the country. These grants for specific regions or areas that need private parties (non profit or profit) to complement ones that cannot deal with all the demand on that particular place or that need to supplement on specific fields of expertise or disciplines not provided by the current government health centers.

Migrant Health Center Program

This program is meant to provide assistance for funding health centers for migrants; from normal assistance to specific needs of those who migrate from abroad or interstate. There are many coordinated by migrant populations that group up to protect themselves and through these programs, the government contributes to fund those projects that have a significant importance.

Health Care For the Homeless Program

Those who are homeless experience significant more hazards and diseases and therefore need health care and use health services often. Since they are homeless, the lack of health insurance needs to be compensated with public or private non-profit medical assistance. Health Care who specialize in assisting the homeless can obtain funds through these health care for the homeless grants programs

Public Housing Primary Care Program

There are many public housing facilities out there to protect the homeless and provide them with a roof for different periods of time. These facilities need to provide primary care services too. Public housing primary care grants programs are meant to fund these facilities and provide them with the money needed to assist those making use of public housing. Only simple medicine practice and procedures are performed in these places but nevertheless, funding is always needed.

School-Based Health Center Program

Just like public housing, schools also need primary health services covered for accidents or common diseases that can affect students that are underprivileged, need immediate assistance or don't have insurance coverage. For these situations, schools that need assistance to fund the necessary facilities and hire the staff to do the job, can obtain financing through school based health center grant programs.

Requirements For Approval

Only private, charitable, tax-exempt, non profit organizations or public entities are eligible for these government grants. However, there are also private institutions providing funds for these same purposes.
Therefore, there are funds available for almost anyone who is worried about providing health care for those who cannot afford private medical solutions.

A Prescription For the Health Care Crisis

With all the shouting going on about America's health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it---people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they've encountered it, when people who've spent entire careers studying it (and I don't mean politicians) aren't sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he'd spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Though I've worked in the American health care system as a physician since 1992 and have seven year's worth of experience as an administrative director of primary care, I don't consider myself qualified to thoroughly evaluate the viability of most of the suggestions I've heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.

THE PROBLEM OF COST

No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we've spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we've been getting for each dollar we spend.

WHY HAS HEALTH CARE BECOME SO COSTLY?

This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can't attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country's GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).

Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.

Is it because of monstrous profits the health insurance companies are raking in? Probably not. It's admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of $346.7 million, which, if projected out, predicts a yearly profit of around $1.3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it's unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately $13 billion per year. Total health care expenditures in 2007 were $2.2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren't likely different by any order of magnitude).

Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it's hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was $2.2 billion, only 0.1% of $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year.

Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately $216 billion (see Table 2, page 4). Though this amounted to 10% of the $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.

Is it from administrative costs? In 1999, total administrative costs were estimated to be $294 billion, a full 25% of the $1.2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it's hard to imagine it's shrunk to any significant degree since then.

In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:

1. Technological innovation.

2. Overutilization of health care resources by both patients and health care providers themselves.

Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they're treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don't have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we've figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we're great at doing in the United States is making technology available.

Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What's not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies---but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn't important---just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.

Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, "The Cost Conundrum," Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.

A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:

1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven't been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain "red flag" symptoms are present, most doctors would refer. If not, some would and some wouldn't depending on their training and the intangible exercise of judgment.

2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.

3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.

4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).

5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they're receiving a straight salary.

Gawande's article implies there exists some level of utilization of health care resources that's optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).

How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient---the "sweet spot"---in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn't mean every physician knows it or provides them. Data clearly show many don't. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.

In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.

But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next---

WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?

According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families---Implications for Reform, growth in health care spending "can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care." When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you'd be spending 60% of your income on health care but that as a result you'd enjoy, say, a 30% chance of living to the age of 250, perhaps you'd judge that 60% a small price to pay.

This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn't what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?

People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don't realize that we're already rationing at least some of it. It just doesn't appear as if we are because we're rationing it on a first-come-first-serve basis---leaving it at least partially up to chance rather than to policy, which we're uncomfortable defining and enforcing. Thus we don't realize the reason our 90 year-old father in Illinois can't have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn't). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we're so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).

So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980's (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn't want to give up.

But how do we decide whether we're getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn't provide great clinical benefit---demented patients score higher on tests of cognitive ability while on it but probably aren't significantly more functional or significantly better able to remember their children compared to when they're not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.

Who's best positioned to judge the value to society of the benefit of an innovation---that is, to decide if an innovation's benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public's views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone's imagination).

THE PROBLEM OF ACCESS

A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance---emergency rooms---which has significantly impaired the ability of our nation's ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors' appointments, long wait times in doctors' offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.

GUIDELINES FOR SOLUTIONS

As Freaknomics authors Steven Levitt and Stephen Dubner state, "If morality represents how people would like the world to work, then economics represents how it actually does work." Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there's always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.

Here then is a summary of what I consider the best recommendations I've come across to address the problems I've outlined above:

1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It's harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn't be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group's higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory "open enrollment" period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that's driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of "good" and "bad" insurance that's currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a "public option" insurance plan open to all, I worry that if it's significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another's health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a "public option" remains comparable to private options, the very people it's meant to help won't be able to afford it.

2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn't have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that's true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let's not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I'm not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.

3. Decrease overutilization of health care resources by doctors. I'm in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what's truly best for their patients? The idea that external bodies---whether insurance companies or government panels---could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients' welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient's consideration, as long as they're careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn't). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients' welfare, meaning doctors' salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn't seemed to promote shoddy care when doctors feel they're being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.

4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:

* Making available the right resources for the right problems (so that patients aren't going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the "sweet spot" with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we've been seeing for the last decade).

* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don't actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it's just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should---we'd just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).

* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can't have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current "pre-pay for everything" model does.

CONCLUSION

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

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