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Emergency Food Supply and Survival Kits

Starting an emergency food supply is something you probably have on your list of things to do. With your busy schedule, it’s understandable if you haven’t gotten around to it. However, accounting for a rainy day is simple to do by taking the right steps.

Accounting for storable food is like saving a percentage of your paycheck. It builds your sense of responsibility and motivates you to be more organized in your daily life. With a third of Americans having less than $1000 in savings, you can imagine that the percentage of people with an emergency food supply is quite small.

Quick Emergency Food Supply Kit Navigation

What Is Food Storage?

Food storage is the act of preserving food in a way that allows you to consume it at a later time. The process may involve growing your own food, purchasing it from a supplier as well as storage and logistics.

Storing food is more than buying a few cans of non-perishables and throwing them in a pantry. You need to determine the length of time for which you are storing food as well as keeping track of stock. A First In, First Out, or FIFO system is probably what you will be applying to your storage. This means that the food stored first should be the first to be consumed to prolong the lifespan of your stock.

Modern methods of food preservation include freezing, canning, pasteurization, irradiation and chemicals. Advances in food packaging materials play an important part in food preservation.

Why You Should Consider Food Storage for You and Your Family

In the age of the internet and big grocery stores, people have become detached from the practical aspects of food. Much like mobile devices make us less reliant on our memories, easy access to food is something most people take for granted.

Food storage allows you and your family to regain some of the valuable lessons that the Earth provides. Knowing how to preserve and store food is a great way to bond with your loved ones while learning the secrets of nutrition and food preservation. Children that participate in your food storage efforts are likely to be more responsible and better understand the workings of the world around them.

Furthermore, food storage is a great way to reduce the anxiety that comes with living in a busy world. Just like having some cash saved gives you the peace of mind that you can deal with an unexpected expenditure, food storage allows you to take comfort in the fact that your food supply runs beyond what’s in your fridge and cupboards.

Ready to Eat Foods

Ready to eat food refers to anything that you can consume without cooking or extensive preparation. This includes food that you have cooked in advance and can be stored to be eaten in the future. Cold sandwiches, salads and smoked fish are examples of ready-to-eat foods.

Prepacked Foods

Prepacked food is any food that you put into packaging for future consumption. The packaging can fully encapsulate the food item or be partly open to allow for airflow, depending on what you are storing. Deciding on prepacked foods for your emergency food supply has to do as much with the type of food you’ll be storing as well as the packaging.

If you store prepacked food in meal portions, cartons and other types of packaging can create extra bulk that reduces your storage space. On the other hand, canned goods are convenient and easy to stack in a garage, pantry or other storage space.

MREs

The Meal, Ready-To-Eat, or MRE, is a self-contained full meal packed in a special meal bag. The MRE is a concept that comes from the military and has the history and know-how of actual military operations supporting it. MREs are lightweight enough to fit into a pocket and are ready to eat upon opening.

Military MREs can last for up to three years and in temperatures of up to 80 degrees Fahrenheit. Cold storage may extend shelf life if it occurs before distribution.

Account for Water Storage

No food storage effort is complete without the appropriate amount of clean water to match. The CDC recommends storing at least one gallon of clean water per day for each person in your household. If you have pets, you should store an additional gallon per day for each one.

If you’ll be relying on water you buy from a store, make sure to replace it every few months. For this, you’ll need to keep track of the expiration dates on the bottles.

A water filtration system will prolong the amount of time you can last without access to fresh bottled water. There are different types of filtration systems for any contingency. A system you attach to your faucet can provide clean water for as long as you have filters you can replace.

Buying a gravity-fed water filtration device is a great backup for your main filter. Some gravity-fed filtration systems are portable, giving you the flexibility to filter water from any source.

Do-It-Yourself

If you have time to spare, you can prepare and package your emergency food supply yourself. There is a bit of a learning curve involved but it may be worth the effort to learn the processes behind the preparation of many of the products you buy at the local store.

Dehydrating Food

Dehydrating food allows for a lengthier preservation window than their fresh counterparts. You can dehydrate milk, meats, soups and many other basic foods. Dehydrating food causes most bacteria to die or become inactive. This makes dehydrating food and placing it in air-tight containers a safe option.

Freeze-Drying

Freeze-drying foods removes moisture while allowing the food to maintain more of its taste than dehydration. The food is frozen and placed in a vacuum so that air cannot cause it to spoil. Fruit and coffee are among the most commonly freeze-dried items. Keep in mind that freeze-frying food may cause some nutrients such as vitamins to be depleted.

Other DIY Methods

Other ways of preserving food for your emergency food supply include canning, pickling, pasteurizing, fermenting and addition of chemicals. The three categories of chemicals used to preserve foods are nitrites, benzoates and sulfites. Scanning a few labels from food purchased at the supermarket will reveal a number of these chemicals in some of your favorite products.

Emergency Food Supply Kits

If you don’t have the spare time to prepare your food supply, some options can eliminate the hassle. Emergency food supply kits are a convenient alternative for people that want to create an emergency food supply but lack the time and experience.

If you want the best of both worlds, you can complement your DIY efforts with emergency food supply kits.

Best Practices and Tips

Maximizing efficiency should be a priority when building an emergency food supply. Knowing a few simple tips can ensure the sustainability and cost-effectiveness of your efforts.

Consider Buying a Generator

Food can last up to 48 hours in a freezer if the power goes out. However, you may need to open your freezer to remove some of its contents. Opening a freezer or refrigerator will cause the temperature to rise within the appliance. A generator can be a valuable way of extending the time your frozen foods can remain safely stored if the power goes out. A functioning freezer will expand the list of food items you can store long-term to include meats and fish.

Store Food With High Caloric and Nutrient Content

When planning your emergency food supply, caloric density and nutrients should be a top concern. Try to choose energy-rich foods that don’t occupy large amounts of space per unit.

For example, beans, rice and oats are foods that contain protein and carbohydrates. Uncooked quinoa can last for nearly eight years while providing you with a high-quality source of vitamin E, amino acids, calcium, lysine and iron.

Stock up on Multi-Purpose Foods

The greater the number of types of meals your stored items can be used to create, the more useful they are. Emphasize storing foods that can serve many purposes and with which you can create different meals.

Herbs and spices have lengthy shelf lives while allowing you to season different dishes. Make sure you store important staples like flour, dehydrated eggs and salt. You can use these ingredients to make bread or sauces.

Raw honey is a multipurpose food that can be consumed on its own, can accompany a healthy breakfast or be used for tea. Honey is a natural disinfectant with antibacterial properties. Its high sugar content makes it an ideal multi-purpose food for your food supply.

Buy in Bulk

Whether you are going the DIY route or investing in emergency food supply kits, buying in bulk is the way to go. In the first case, purchasing sufficient quantities of grains, rice, beans, nuts and flour will drive down your cost per unit. You can then place these items in appropriate containers for long-term preservation and storage.

If, on the other hand, you are considering a done-for-you solution, you can select between two-day, one-week, two-week, and four-week emergency food supplies. Most emergency food supply kits can last for 25 years and are packaged in durable containers. They offer a fixed daily calorie intake so you don’t have to worry about getting your day’s worth of energy and nutrients.

Start Your Emergency Food Storage Today

An emergency food supply is an exercise in responsible planning and logistics. Luckily, the process is not that complex. Storing nutritious food and clean water is worth the effort and gives you peace of mind for years to come.

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Total Knee Replacement Surgery

Joints in healthy conditions are vital to normal functions. This is especially true of the major joints, like the knees. The knee is the largest joint in the body. If it is injured or deformed by trauma or arthritis, daily living tasks can be rendered extremely difficult. In certain cases, total knee replacement surgery may be called for when non-surgical options do not suffice.

Table of Contents

Anatomy of the Knee

Healthy knees are vital elements in the performance of most everyday activities. They are the largest joints in your body; joints being the areas where two bones, or more, meet. Your knee is an interesting mechanism, with structures working together for the ensurance of smooth and natural movement and function. Basically, your knee is a pair of long bones of the leg held together by tendons, ligaments, and muscles. A layer of cartilage covers each bone end, absorbing shock while protecting the knee.

Two groups of muscles play a part in the knee. At the front of your thigh are the quadriceps muscles; these straighten your leg. At the back of your thigh are your hamstring muscles; these bend your leg at your knee. Along with the muscles, tendons and ligaments are required for proper function of movement. Your tendons are cords of tough connective tissue joining muscles to bones. Ligaments are more elastic; they are bands of tissue connecting bone to bone. Some of your knee’s ligaments provide stability while protecting the joints. Others limit the movement of the shin bone, or tibia, in a forward and backward motion.

Components of the knee include:

  • Tibia: the shin bone, which is the larger bone found in your lower leg
  • Femur: the thigh bone, which is your leg’s upper bone
  • Patella: Your kneecap.
  • Cartilage: A variety of tissue covering the bone’s surface at a joint. It helps reduce friction when a joint moves
  • Synovial membrane: This is a tissue lining the joint, sealing it within a joint capsule. It secretes synovial fluid, which is sticky and clear, around your knee, lubricating it.
  • Ligament: Tough, elastic tissue that connects bones to bones, surrounding the knee to provide support and limit its movement.
  • Tendon: A tough type of connective tissue connecting bones to muscles, helping ot control the knee’s movement.
  • Meniscus: A curved portion of the cartilage found in knees and other joints. C-shaped, it acts like the knee’s shock absorber, increasing contact area while deepening the joint of the knee.

Common Causes of Knee Pain

Knee pain, a common complaint, can impact people of any age. It may appear as a result of an injury, something like torn cartilage or a ruptured ligament. Medical conditions may also cause pain in your knees; these include arthritis, infections, and gout. The symptoms of knee pain can vary. Signs include redness of the knee joint, warmth when you touch it, swelling of the knee or stiffness there, weakness or instability, inability to straighten your knee fully, and noises such as popping or crunching.

Injuries

The injuries that can cause pain in your knees are varied. They include ACL injuries, which refer to a tearing of your anterior cruciate ligament. This is one among four ligaments connecting your shinbone and your thigh bone. ACL injuries are particularly experienced in people who play sports like soccer or basketball; these require abrupt changes in direction. Fractures are another injury of the knee.

The bones, including the patella, may be broken during falls or motor vehicle collisions. Those with bones weakened by osteoporosis can occasionally sustain a knee fracture simply by taking a step wrong. A torn meniscus can occur if you twist your knee suddenly while it is bearing your weight. Knee bursitis may be the result of an injury; it causes inflammation in the bursae, which are small fluid sacs cushioning the exterior of the knee joint. These bursae permit the smooth gliding of the ligaments and tendons over the joint. Finally, an injury likely to strike the knee is patellar tendinitis. This inflammation and irritation of the patellar tendon often strikes runners, cyclists, skiers, and anyone in a jumping sport or activity.

Mechanical Problems

Sometimes mechanical problems afflict the knee joint. These causes of pain include a loose body, which involves injury or bone or cartilage degeneration causing a piece of cartilage or bone to break away, floating in the space of the joint. This only causes problems when it interferes with the movement of the knee. The knee then is rather like a door hinge with a pencil caught in it. A dislocated kneecap may also be the source of knee pain. This occurs when the patella slips from its place, generally to the knee’s outside. Sometimes, this dislocation is visible to the naked eye.

Hip or foot pain can also be a mechanical problem that affects the knee. Because of these kinds of pain, you may change the way you walk to spare them. This alteration of your gait may place further stress on the knee. In these cases, hip or foot problems can result in knee pain. Finally, iliotibial band syndrome can hurt the knee, especially in distance cyclists and runners. It occurs when the iliotibial band, which is tough tissue extending from your hip’s outside to your knee’s outside, grows so tight that the result is rubbing against the femur’s outer portion.

Arthiritis Varities

rthritis exists in over 100 types, but only a few are likely to impact your knee. One is osteoarthritis, also known as degenerative arthritis. The most common variety of arthritis, this condition occurs when wear and tear in your knee cause its deterioration with age and use. Gout is another; it occurs when there is a build-up of uric acid crystals in your knee. Rheumatoid arthritis is the arthritis in its most debilitating form. It is a condition that is autoimmune and can impact nearly any joint within your body, including the knees.

Pseudogout is often mistaken for gout; it is caused not by uric acid crystals but calcium-containing crystals. They develop in the fluid of the knee, which is the most common joint to be affected by pseudogout. Finally, septic arthritis is a type of arthritis striking the knee. Sometimes the knee becomes infected. This leads to pain, swelling, and redness. Septic arthritis generally occurs with your fever, causing extensive damage to your knee cartilage.

Other Knee Pain Causes and Risk Factors

A general term referring to pain that arises between the patella and its underlying femur is patellofemoral pain syndrome. It is commonly found in athletes, in young adults whose kneecap encounters maltracking, and in older adults, who develop it as a result of patellar arthritis.

Risk factors of knee pain include carrying excess weight on the body. Overweight and obese people have increased knee joint stress, even in such ordinary activities as using stairs or simply walking. Lack of muscle strength or flexibility increases the risk of injury to the knee. Strong muscles stabilize and protect the joints, while muscle flexibility aids in achieving a full range of motion. A previous injury also increases your likelihood of re-injury. Finally, some sports and occupations put more stress on the knees than others. These include, for the former, sports like alpine skiing and basketball, and for the latter, jobs like farming or construction, which place repetitive stress upon the knees.

 

Overview of the Procedure

Types of Knee Replacement

Four types of knee replacement are available. These options feature total knee replacement, where the entire knee is replaced; partial or unicompartmental knee replacement; where only those parts of the knee which are affected are replaced; kneecap replacement or patellofemoral arthroplasty, which replaces the kneecap; and bilateral knee replacement, where both knees receive simultaneous replacement.

In addition to the different types of surgery, there are different kinds of new knee joints for you to consider. Along with your doctor, your orthopedic surgeon will assist you in deciding the best choice for you. They will consider your knee’s condition and your overall health when making this decision with you.

If arthritis only affects a single side of your knee, you can have a unicompartmental or partial replacement. This is a half-knee replacement. It involves less interference than a total knee replacement has on your knee. This results in better function and a quicker recovery. A smaller incision is involved with this surgery, using techniques called minimally invasive or reduced invasive surgery. The smaller incision might further cause a recovery time reduction. This surgery is not for everyone. You need healthy, strong ligaments in your knee; unfortunately, sometimes this is not known before the incisions are made for the surgery.

Description of Knee Replacement

Also known as knee arthroplasty, a more accurate term for a knee replacement might be knee resurfacing. After all, the bones are not wholly replaced; only their surfaces are. This procedure has several basic steps. The first is to prepare the bone surfaces. Your surgeon removes damaged cartilage located on the surface at the femur’s and tibia’s ends, along with small amounts of underlying bone. Then the surgeon positions the metal implants. This involves replacing the removed bone and cartilage with metal components. These recreate the joint’s surface; they may be cemented into the bone or press-fit there.

Third, the patella needs to be resurfaced. The undersurface of the kneecap gets cut and resurfaced; the surgeon uses a plastic button. However, some surgeons do not perform step three, depending on the case’s condition. Finally, the surgeon inserts a medical-grade plastic spacer between the metal components. This creates a gliding surface that is smooth.

Is Knee Replacement Right for You?

Total knee replacement is a surgery considered for patients who have knee joints that have received damage from trauma, progressive arthritis, or rare destructive joint diseases. Osteoarthritis is the most prevalent reason in the United States for knee arthroplasty. What these causes have in common is that the result is progressively increasing stiffness and pain while daily function decreases. At this point, it is time for many to consider total knee replacement.

The time might be right for you to consider knee arthroplasty when medications cease to help in easing your pain. When even the strong anti-inflammatory drugs do not work, relief might need to be sought in surgery. This is also true of the circumstances when other options that are less invasive do not work. These can include cortisone injections, rest, physical therapy, and lubricating injections. If your pain is debilitating, it may be time for surgery. When you find yourself struggling to perform certain tasks only with difficulty and pain, this is often the case. Such tasks include getting dressed, bathing, rising from a chair or your bed, or climbing stairs.

Other factors indicating that the time is right for knee replacement surgery include needing a cane’s or walker’s aid to get around, your pain being severe both night and day, even when not using the knee joint, or your knee joint is deformed. This latter may be due to injury or because of arthritis. If it bows in or out severely, surgery can become more difficult. When severe deformity is present, seek help sooner. Finally, it might be time if you are between the ages of 50 and 80. Most knee replacements occur on patients in this age range, although age is not a deciding factor in many. Surgeons perform this procedure on patients who run a wide range of ages.

There are other times when you might decide that it is not yet time for knee surgery. You may still have time for more conservative treatments to have a chance, for instance. If rest, heat, ice, exercises to strengthen the muscles, and medications for pain help, keep using these tools instead. If your pain is bearable with medications that still help, you can delay. This is also true if you can get around well with little difficulty in performing your daily activities. If you are very overweight, have weak muscles in your thighs that would not support new knee joints, or if you have open sores or ulcers in the impacted region that might become infected post-surgery, you and your doctor may decide against it.

When is Surgery Recommended?

Forms of arthritis such as osteoarthritis and rheumatoid arthritis can cause the knee pain and deformity. Not everyone who suffers from knee arthritis is right for total knee replacement, however. Doctors use certain guidelines when deciding whether or not to recommend this surgery. Eligible patients experience knee pain that is interfering with their daily living without responding to non-surgical treatments such as bracing, injections of steroids or lubricants, or physical therapy. They also have severe to moderate arthritis in the knee. This is confirmable with medical imaging.

In general, typical candidates also have a combination of difficulty walking, rising from and sitting down in chairs, and using stairs; severe to moderate pain even at rest, which might impact sleep; a deformity of the knee or knees, such as knock-knees or bow-legs, resulting from or exacerbated by the degeneration of the knee; and swelling and inflammation of the knee that is chronic and uncontrolled by rest or medication.

Medical Evaluation: 

An orthopedic surgeon will evaluate your case and condition. This consists of a number of components. The first is a medical history. The orthopedic surgeon gathers information regarding your general health, asking about the breadth of your knee pain along with your ability to function with it. Then comes a physical examination. Your surgeon assesses knee motion, strength, stability, and leg alignment overall. X-rays come next; these images help your orthopedic surgeon determine your knee’s extent of deformity and damage. Other tests follow. These may be an MRI, a magnetic resonance imaging scan, or blood tests.

After the test results have received the surgeon’s review, the orthopedic surgeon will speak to you about those results, discussing whether or not you are an eligible candidate for such surgery or if other treatment options would best suit your case. You will also hear the potential risks involved in the surgery and the time following the surgery, while you recover and beyond. It is important to have realistic expectations when it comes to total knee replacement surgery. Most of those who have received the surgery are relieved to find a dramatic reduction in their knee pain with a significant improvement surrounding the category of normal daily life activities. What this surgery does not do, however, is permit more than you could do before the arthritis developed.

Possible Complications in Surgery

In fewer than two percent of patients, serious complications occur. While the complication rate is low, surgery always carries the risk of complications. If you have concerns about this, discuss them with your surgeon before the procedure. Remember that chronic illnesses can increase the likelihood of complications, and that, although they are uncommon, when they occur, these complications can limit or prolong recovery.

Infection

Infection is one such complication. It can occur in the wound. An infection may also strike deep about the prosthesis. Such a problem can strike within days, weeks, or even years of a surgery. While generally treated by a doctor with antibiotics, deep or severe infections may call for further surgery. The prosthesis may even require removal. Infection anywhere in your body can develop and then spread to the knee joint replacement.

Blood Clots

Blood clots are another complication. One of the most common problems that can occur in knee replacement surgery, leg blood clots can be life-threatening. This happens when they break away and then travel their way to your lungs. Your surgeon will give you a prevention program, entailing such things as regularly elevating your legs, performing lower leg exercises for the increasing of circulation, snug support stockings, and blood-thinning medications.

Other Problems

Implant problems may also occur, despite the fact that implant designs and the materials of which they are constructed continue to advance. Surfaces may also wear down, their components loosening. The knee may also scar, limiting motion. Further problems include bleeding, fracture, continued stiffness post-surgery, neurovascular injury, which is an injury to the blood vessels or nerves around your knee during surgery, and continued pain after surgery.

How to Prepare for Surgery

Consuming Medications and Food

After your doctor has explained the details of the total knee replacement surgery to you, you will sign a release form for the treatment. Your doctor will advise you if you should halt the use of certain medications or dietary supplements prior to your procedure. Most likely, you will be instructed to avoid food or drinks other than water after midnight on the day of your surgery.

Recovery Preparations

You may need to use a walker or crutches for several weeks following the procedure. Arrange for these prior to the procedure and ensure the floor plan of your living spaces has room to move around with these. You should arrange for a ride to get back from the hospital as well as assistance for everyday tasks. You will need help with cooking, laundry, and bathing, among other tasks. If you happen to live alone, a hospital discharge planner may suggest a potential temporary caretaker

Living Arrangements

While looking at the arrangement of your home, create a living space on one floor. Climbing stairs will be challenging at first. Have safety bars installed in your bathroom and a secure handrail in your bath or shower. Double-check that stairway handrails are solidly secure. Acquire a stable chair; this should have a firm seat and back cushion. A footstool will help you keep your leg elevated. Get a bench or chair for the shower, arranging for an elevated toilet seat if your toilet is low. Finally, remove loose cords and rugs.

Evaluations

Get your teeth checked prior to a knee replacement surgery. While the incidence of infections post-surgery is low, infection can still strike if bacteria should enter your bloodstream. This can occur through unresolved poor dental care. If you will need extractions or periodontal work, complete it before the knee operation. Next, a urological evaluation is important if you have recently had a urinary infection or if you have a history of such infections on a frequent basis.

What Happens During Your Hospital Stay

Before the Surgery

First comes anesthesia. Your preference and input assist the team in deciding whether they should use general anesthesia on you, which renders you unconscious, or instead an option that leaves you aware but unable to register pain from the waist down, spinal anesthesia. Before, during, and post-surgery, you receive an antibiotic intravenously. This helps protect against post-surgical infection. A nerve block may also be administered to numb the knee. This numbness gradually wears off following the procedure.

During the Surgery

Because all surfaces of the joint need to be exposed for the surgery, your knee will be positioned in a bent fashion. After an incision is cut that stretches between six to ten inches in length, your orthopedic surgeon moves the kneecap aside to cut away the damaged surfaces of your knee joint. After a preparation to the surfaces, your surgeon attaches the artificial joint’s pieces. Prior to closing the incision, the surgeon rotates the knee and bends it, testing it so that proper function is ensured. The procedure requires about two hours to perform.

After the Surgery

Once you are removed from the anesthetic after you are closed up, you are taken into a recovery room. Provided all goes well, you will be there from one to two hours. You then travel to your hospital room. In most cases, you will have a stay of a couple of days. Your surgeon will prescribe medications to help control your pain. While you are in the hospital, you will be encouraged to regularly move your ankle and foot. This increases the flow of blood to the muscles of your leg, preventing swelling as well as blood clots. Compression boots, support hose, and blood thinners may be used to further prevent swelling and clotting.

Medications

Pain-killing medications may include NSAIDs, or nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, and local anesthetics. Your doctor may prescribe these individually or in combination, generally preferring to minimize any need for opioids. A caveat of taking pain medications is that while opioids do help relieve post-operative pain, they are a potentially addictive narcotic. Opioid dependency, along with overdose, is a critical health issue in the United States. Use opioids only as directed and stop taking them as soon as your pain begins to ease.

Physical Therapy

The day following surgery, at most, you will meet with a physical therapist. Sometimes you meet with this type of specialist hours after your surgery. A physical therapist teaches you specific exercises that will strengthen your leg, restoring knee movement. The end result of these exercises is normal walking and daily activities. Follow these exercises at home as you continue recovering.

Post Surgery Care

For the optimal outcome following your total knee replacement, you need to continue in outpatient physical therapy and follow the wound care instructions given by your hospital team. It is important that you continue exercising the muscles that surround the replaced joint for the prevention of scarring and contracture, maintaining muscle strength so the joint receives stability. Such exercises can reduce your recovery time and lead to the best possible results. The surgical staff will monitor the wound for healing. You should also keep an eye out for signs of infection. These include abnormal redness, swelling, increasing warmth, and unusual pain. Report any such signs, as well as injuries to the joint, at once to your doctor.

How to Avoid Problems Following Knee Surgery

Move around as directed to prevent blood clots and encourage healthy muscle repair. Moving the ankle and foot is also helpful, so do not neglect exercises that include them. Wear support hose or compression devices if you are instructed to do so. Know the signs of a blood clot. The warning signs include increasing calf pain, tenderness accompanied by redness below or above your knee, and swelling that is new or increasing in your foot, ankle, and calf. A warning sign of a pulmonary embolism, when a blood clot has made its way to your lung, feature abrupt shortness of breath, localized chest pain accompanied by coughing, and abrupt onset of chest pain.

Avoid falls following your surgery. Use care when moving around, but do not neglect motion. Exercise is critical in recovery, particularly in the first few weeks following surgery. Three to six weeks after the surgery, you ought to be capable of resuming most normal functions of life. Your hospital team will instruct you in the use of assistive aids following your surgery.

Knee Surgery Outcomes

While an improvement to your knee’s range of motion is a goal of replacing your knee, restoration of full motion does not often occur. Most patients are able to straighten their new knees almost fully, bending them sufficiently to enter and exit a car or to climb stairs. Kneeling can be uncomfortable but does not harm the joint.

Numbness in the skin around the incision is not uncommon; neither is stiffness when excessive bending is practiced. Most people also hear or feel clicking in the plastic and metal while walking or bending the knees. This is normal and often diminishes with time. The new knee may set off security-placed metal detectors in airports and other secure buildings. Inform the security agent that you have had a knee replacement surgery if this takes place.

Extending the Life of a Knee Replacement

At present, greater than 90% of modern knee replacements still function well a full 15 years post-surgery. Follow your orthopedic surgeon’s instructions upon completion of your operation. Take care to protect the knee replacement and your health in general. When well-cared for, a new knee replacement should last at least 20 years, if not longer. A partial knee recovery may require further surgery after about ten years. These are important ways to contribute to the continuing success of your procedure.

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Emergency Room or Urgent Care?

Should You Go to the Emergency Room or Urgent Care?

Sudden illnesses or injuries often occur with no warning. One evening while preparing dinner, you accidentally cut your thumb. The pain is so intense, and it seems like a deep cut, so you don’t know whether you need to visit an emergency room or visit an urgent care center. Such situations are disturbing, and it’s hard to think right due to the stressful conditions.

You first need to determine the level of medical care you need to get appropriate help quickly. Again, you need to understand the difference between various care facilities to get the right treatment and save time and money. Read on to gain more insights.

Table of Contents

Differences Between Walk-In, Urgent Care And Emergency Rooms

As the healthcare sector continues to evolve, there are various options that you can consider to get medical attention, depending on the severity of your situation. The cost of making the wrong decision is exceptionally high. Here is a quick overview of the different health facilities to help you make an informed decision. A walk-in clinic is a place where you can visit a medical practitioner without an appointment. However, in some cases, the urgent care and emergency room hospitals also offer walk-in services. The walk-in clinics serve quick, less complicated medical needs. On the other hand, if you need medical care due to minor injuries that can’t wait for an appointment or when your doctor is unavailable, you can seek urgent care services. They are also walk-in clinics that handle after–hours care for non-threatening illnesses that don’t require emergency attention. Urgent care can treat more severe conditions than walk-in clinics. Emergency rooms deal with significant health problems that require immediate attention. Such facilities operate around the clock to prevent death or severe impairment of the patients.

When To Go To The ER

If you have a life-threatening condition, you need to go straight to the nearest emergency room. Severe shortness of breath could be an indication of cardiovascular issues that requires urgent attention. Also, allergic reactions that result in swelling of the tongue can compromise your breathing, so seek emergency help. Again, if you experience severe chest pains, it could signal a heart attack, which deserves instant attention. Further, visit an emergency room if you notice sudden paralysis, confusion, or troubled communication. Emergency rooms have CT scans and other machines that can diagnose stroke. If you experience fever, severe abdominal pain, nausea, fatigue, and stomach swelling, you could be suffering from gastrointestinal issues. If left unattended, gall balder attack, pancreatitis, and appendicitis can cause significant complications. Again if you are dealing with life-threatening injuries like continuous bleeding, broken limb, rush to an emergency room. Note that non-urgent issues will only lead to unnecessary testing, excessive healthcare spending, and time wastage. Only seek emergency help when you experience the above or any of the following symptoms; • Head or eye injury • Seizure • Severe cold or flu symptoms • Vagina bleeding while pregnant • Fainting • Fever with rash • Loss of vision • Severe burns • Coughing up blood

When To Call 911

If your instincts tell you that you have a severe medical issue that requires immediate attention, call 911. Don’t drive yourself to the hospital if you have severe chest pains, impaired vision, or excessive bleeding. If someone faints near you, call 911 to get them to an emergency facility as quickly as possible. Also, for heart attacks, call 911 for an ambulance so that the medics can administer lifesaving treatment right away before getting to the hospital. However, when you call 911 for non-emergency cases, the dispatchers might get flooded, and someone experiencing a life-threatening issue may not get the help they need.

When To Get Urgent Care

The urgent care centers handle more serious but non-life-threatening injuries or illnesses. If you cut yourself, and the bandage doesn’t seem to work, but you can’t spot a bone or any worrisome tissue, you may seek urgent care. The medical practitioners will clean and stitch your wound quickly to prevent further infections. In fact, 84 % of the critical care patients finish their session within an hour. Additionally, if you experience flu that won’t respond to home treatment, urgent care will be helpful. At times, you could be suffering from minor respiratory issues. Also, visit your nearest urgent care center if you experience chest pains and don’t have a heart disease history. Urgent care clinics can also handle minor bone fractures at the ankle, hand, finger, foot, or ribs. When you can’t reach your primary doctor, you can visit an urgent care center. One main benefit of such facilities is that they operate all days, including weekends and holidays. However, avoid over-relying on urgent care centers for routine clinics and checkups. Only go there to complement your preventive care when something comes up or for the following treatments. • Animal bites • Sore throat • High fever • Minor burns • Sinus • Skin problems and rashes • Vomiting, diarrhea and minor stomach pains • Urinary tract infections • Sprains and strains

When To Go To A Walk-In Clinic

Visit walk-in clinics when you need quick and convenient access to medical care. You are likely to find a nurse or physician assistants who can handle minor injuries and illnesses that can’t wait. One great thing about such facilities is that they provide on-demand care without appointments. They also operate for long hours, beneficial to those with fixed schedules. They can to treat issues like; • Fever • Mild cold or flu • Back pain • Sprains • Mild eye injury • Ear pain • Cough and congestion • Minor cuts or burns They are a great option when you aren’t feeling well, but you don’t need emergency assistance. Others even administer vaccines.

How To Prepare For Your Health Facility Visit

Now that you know what care facility you need to visit in different situations, it’s essential that you prepare adequately to get the most out of your visit. Since most facilities accept walk-in, check-in online to minimize your waiting time. Call the facility earlier enough to reserve a slot, and you can even provide them with your initial information so that the medical practitioner can prepare for your arrival. Additionally, it would be best to find the right facility earlier. Always have an option in mind, so don’t wait until when you get sick. Do background research and pick a facility that specializes in the care you need. For instance, some hospitals deal with women’s health, while others handle children’s needs. Spot hospitals near your location and familiarize yourself with their working hours. Whether you want to visit a walk-in, urgent care, or emergency room, you must carry along with a list of all your medications. Include vitamins and any other supplements that you use and the amount. It would be best to present a list of your past hospitalizations, medication allergies, and any previous procedures you have had. In case of surgeries or any other serious procedures, you must include the date and the name of the practitioners who performed them. Such information is incredibly beneficial, especially when in an emergency room since it will help the doctors administer the best possible treatment. Although you can visit walk-in clinics and urgent care facilities at any time, note the less busy periods. It could be during the weekends on holidays or at night. The longer the line, the more time you will take before getting help. Remember that the less busy a facility is, the quicker you will get help. Again, don’t go to a clinic or urgent care facility when you have a life-threatening issue. It’s very dangerous since the facilities might not have the right equipment to handle your situation.

What To Expect From Various Care Facilities

Different health care facilities vary based on the level of care availed, therefore, expect to have different experiences. Although an emergency room can handle the same issues like the urgent care centers, you are more likely to spend more time. The emergency rooms give priority to critical issues. Again, the treatment sessions can take longer, and you are most likely to waste a lot of time. It’s therefore advisable that you consider urgent care or clinics for less severe issues. 96 % of urgent centers maintain waiting time to 30 minutes or less. By going to the wrong clinic, you will also waste money. Emergency care costs higher, and some insurance restricts emergency room visits. Again, the emergency rooms have various specialists and improved test equipment, thus expect to pay higher. The walk-in clinics and urgent care facilities cost way much cheaper. The cost in clinics depends on the nature of the condition, and they accept most health insurance types. There is, therefore, no need to pay for emergency services if you don’t need that. For non-life-threatening illnesses, you are more likely to get quality care at urgent care centers. Most of these centers operate around the clock, and most of the staff work on a full-time basis. However, always remember that if you visit a health care center and they determine that your case needs a more technical approach, they will send you to an emergency room that will cost you more money and time.

Conclusion

It’s worth noting that all medical conditions, emergency or not, require urgent attention. Therefore, visit the right facility to ensure that you get the proper treatment within the shortest time possible. If you are experiencing mild illnesses, go to a walk-in clinic. If you need more immediate or after-hour care, urgent care centres suit you best. On the other hand, if you experience severe illness that affects your entire body, call 911 to immediately get you to an emergency room. Although choosing where to turn to after an unexpected medical situation can be challenging, the above guide will help solve your dilemma.
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Electronic Health / Medical Record – EHR / EMR systems

Electronic Medical Record Systems (EMR Systems)

Keeping patient medical records safe and easily accessible is something that you strive to achieve daily in the medical field. With more investigation and treatment programs going on, you may not always cram every bit of information about your patients as a health practitioner. However, since information is crucial for successful medical practice, having tools that improve patient data and relationships is essential.

We know paper files have been the store for most patient data for decades. But what happens when you can’t trace specific files? How much effort does it take to go through multiple files to access patient history? These are just some of the questions that prompt the move to Electronic Medical Record Systems as the center of patient medical information.

 

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What is EMR

EMR is an electronic collection of patient medical information and history under a practitioner. This information is gathered, managed and consulted by authorized medical practitioners within one health care organization. In other words, if you are a medical practitioner with one organization, EMR is the patient data collected and shared within authorized staff in the organization throughout the patient’s visits and consultations.

Electronic Medical Records are a replacement for paper technology and an effective flow of communication between healthcare teams. If you have had the pleasure of keeping files on your table for easy access, then you know how easily these documents can get mixed up and cause confusion. You also know how convenient it is to effectively transfer data from one computer to another without losing content; this is where EMR has forced paper records out of the room.

We tend to use the phrases EMR and EHR interchangeably; you may also have used it to refer to the same thing. However, there are differences between the two in how the data is disseminated.

Electronic Medical Records will flow within your healthcare organization and sometimes within a specific practice’s unique workflow. For example, you will come across EMRs specifically for Pediatrics, Cardiology or Ambulatory. EHRs, on the other hand, cover a wider area, and their info can be shared with different medical practitioners in different health organizations to relate a patient’s form of treatment; an EMR will be within an EHR.

Both Electronic Medical Records and Electronic Health Records are necessary for your practice and your patients’ continual care. With an EMR, you have a comprehensive record of care data for your patient for each practice. The record allows you quick access to follow-up, prescriptions, diagnostic results and clinical management. On the other hand, an EHR ensures that you can link with other practitioners in other health organizations to provide care for patients quickly anytime it is needed.

What makes up an EMR

An EMR is like the paper chart you use to follow up patient progress and data, but only with more diagnostic information and better organization. Some of the core modules and components that define an EMR include:

• Patient Demographics
• Charting and documenting patient encounters
• Ordering lab and diagnostic imagine tests.
• Patient Billing.
• Clinical decision supports.
• Prescription and medication management.
• Documentations management.

There are many benefits of Electronic Medical Records for both the patient and the medical practitioner. We will mention a few benefits below:

• You can monitor a patient’s diagnoses and treatments over time.
• You can identify patients who are due for follow-up and routine medical services such as immunization.
• Discover a reduction in medical errors, duplication of tests and delays in treatment.
• You can instantly access medical delays, which saves time.
• Reduced cost of records over time after the initial implementation of EMR.
• EMR allows patients and their families more involvement in the healthcare process through access to resources that help them understand their health situations.

What is an EMR System?

Electronic Medical Record Systems are software that combines all the clinical activity in an office to implement a wide range of functionality and user interfaces for information gathering and management. The EMR system is used every day in a health institution to add new patients, set up insurance e claims, and schedule patient visits.

There are various EMR systems available in the market, and implementing one depends on your overall institution’s needs. The most common EMR software is:

• AdvancedMD
• CureMD
• Epic Care
• athenaOne
• Cerner PowerChart Ambulatory

What do you look for before investing in EMH software?

Cloud-based

How would you like to access medical records? It is an important question to determine if you will go for software that is web-based or cloud-based. Most physicians prefer cloud-based EMR software because they can access their data from smartphones, laptops, tablets, etc. Web-based only software limits data access to devices.

Integrated Practice Management Software

Would you like your EMR system to be stand-alone or integrate a practice management system? An integrated software provides additional services like scheduling, billing and monitoring how your practice performs. Even specialty-specific software face tough competition from EMR integrated practice management software because they offer widespread reporting competencies. The decision will depend on what you want to achieve from the EMR system and how it will help your practice or institution grow.

Specialty -Based EMR Software

If you require unique tools tailored for your specific practice, specialty-specific EMR systems are where you invest. A good example is Cerner PowerChart Ambulatory that is specific for the practice. The documentation is specific to areas of concern with ambulatory medical needs.

Ease of Use and Training

Is the software usage practical and easy for anyone who interacts with it? You do not want to buy software that is too complicated and requires constant, expert knowledge to navigate. Most EMR software will provide training at the time of purchase and sometimes throughout usage with every update. Therefore, go for vendors that can offer you and your staff training to grasp the software better.

Customer Support Quality

Every form of technology will have an issue at some point in usage. You also don’t want to get caught up with errors on your screen with no support to guide you through it. Customer support quality is essential to address your concern and resolve them in a timely and professional manner. Before purchasing an EMR software, you should determine if there will be a special support team to reach out to issues and if it is included in the package.

Practice Size

Depending on your budget and the practice’s size, there are different EMR software that will suit your daily medical data collection and management. If you are a solo practice, a free or affordable cloud-based EMR software is a good

Overview of Current EMR systems

athenaOne

athenaOne was launched by athenahealth EHR Software and has quickly gained ranks as the top medical app for Apple users. The software has an easy-to-use and intuitive interface that will give you an easy time in your medical record management process.

It offers revenue management that your practice needs, and athenaCoordinator allows patients to schedule and review appointments from their homes’ comfort and easily integrates with other EMRs.

The benefits of athenaOne are that it promotes the relationship between you, your staff and the patient for better medical care. Since it is cloud-based, the software allows you to access information from any electronic device and eliminates the risk of losing vital patient information.

Pros

• Friendly user interface
• Comes with training/test site and learning portal to guide you through installation and usage.
• It has excellent tools for documentation quality.
• Simples billing processes.

Cons

• The software is occasionally slow.
• It does not include a treatment plan for chronic diseases.
• Customer service response is slow.
• Quite expensive, but the price is worth it for bigger institutions.

CureMD

CureMD is a top-rated EMR software with all-in-one medical record management features customized for your everyday needs. It is best for small, medium and large practices covering all specialties, County Health Departments and even FQHCs. Every health facility can streamline its processes using this EMR software.

Its features include compliance tracking, e-prescribing, appointment scheduling, a self-service portal for health providers and patients, voice recognition for medical records, and appointment reminders. It is beneficial for the ease with which you can transfer results and referrals between different departments in the healthcare institution.

Pros

• Excellent technical support that handles issues instantly.
• Affordable cost for solo practice.
• Simple and easy to navigate
• It is Cloud-based.

Cons

• Only works with internet explorer.
• Billing procedures are tedious.

Epic Care

Epic Care is a highly rated ambulatory EHR software swerving physicians in hospitals, medical organizations, clinics, independent practices, academic centers and specialty groups. One top feature that stands out for this EMR is the MyChart patient portal that gives your patients access to their health information at the fingertips.

It allows them to message doctors, schedule appointments and attend e-visits. Other features include flexible and pre-built content for your specialties to help you focus on care. You can extend your system to other hospitals and independent communities. It hosts a multitude of functions that allows you to follow up with insurance care and telehealth.

Pros

• It boasts of versatility in clinical and administrative functions for both practitioners and patients.
• It is easy to use; the interface is self-explanatory.
• Patients have access to their medical history and resources via charting.
• It allows you to review the best processes to make the best decisions for future patient care.

Cons

• Customer support is not as receptive as many users would like.
• No shortcuts: navigation is long and frustrating if you do not know how to get around it.

AdvancedMD

AdvancedMD is a dedicated EMR software that enables you to securely work remotely and handle your patient’s medical needs without compromise. This EMR software is among the few that are 100% build on a cloud platform. Comprehensive cloud suites and remote care technologies give you unmatched access to information for your starting or growing practice.

The cloud platform hosted by Amazon Web Services makes the software simple to access multiple devices in a server-free environment. Some of the features included are scheduling, charting, billing and patient relationship management. A patient portal also ensures your patients can access self-help services and resources in AdvancedMD.

Pros

• Flexible pricing options that allow you to pick different pricing models depending on your needs.
• Well-organised user interface.
• Rich features with flexible navigations
Cons
• It has a steep learning curve.
• Training is a must to maneuver the specs of the software.
• The upfront cost may be too much for small practices on a budget.

Cerner PowerChart Ambulatory

Cerner PowerChart Ambulatory is a specialized HER that automates disseminating information in clinical functions to ensure both primary and specialty healthcare teams have the right information at the right time and place for accurate decisions. The ideology behind this EMR is that information technology, and great coordination directly leads to safer and effective healthcare for communities worldwide.

It comes as web0-based, Cloud and SaaS, and you can access it on any smartphone. Documentation is flawless as it provides a one patient-one record systems from registration to the final bill without any mix-ups.

Pros

• Effective in managing clinical orders by classification.
• It is easy to navigate even for first-time users.

Cons

• Limited usage of search feature to look up patients.
• Occasional downtime and server problems.
• Price doesn’t match its features.
• Repetitiveness when entering patient information.

Bottomline

Finding the best EMR system software for your institution or practice is highly dependent on the functionalities and effectiveness you expect from your purchase. The above EMR software is the best pick we can find in the market, suitable for different practice sizes and specialties.

The features in each of the EMR software above are designed to help you streamline the process of sharing, collecting and sending information between healthcare teams in your department. We recommend going through the products carefully and align them with your institution’s goals and budget to choose the system that works best for you.

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Medicare vs Medicaid

Medicare vs Medicaid: Whats the Difference?

The subject of Medicare and Medicaid can be confusing for all of us. Sure, these two programs help a diverse group of people at various stages of their lives. But they aren’t exactly alike. So, what’s the difference between them?

Medicare is a health insurance program set up by the federal government. The Centers for Medicare & Medicaid administer it uniformly throughout the US. People who are disabled or over 65 can receive benefits. Participants pay into it over several years to provide funding for the plan.

Medicaid is a federal and state-run assistance program for low-income individuals and families. As a result, each state differs in the way they administer the guidelines. Also, there are currently no age restrictions for Medicaid.

Key Takeaways:

  • Medicare is a federal health insurance plan for people 65 and over
  • Medicaid is a federal-state health assistance program for low-income individuals and families
  • Medicare has four parts and can be very complicated to understand
  • Medicaid is much simpler but differs from state to state
  • Combining both programs can provide dual coverage for zero out-of-pocket costs

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Medicare overview

Medicare is a federal health insurance program for people 65 and older. It also covers those under 65 with certain disabilities.

Eligibility requirements

The following is a list of current eligibility requirements for Medicare:

  • 65 and older and paid into the system for at least ten years
  • Under 65 but have been disabled at least two years
  • You have ALS ( Lou Gehrig’s disease) or End-Stage Renal Disease (ESRD)

Medicare Part A

The primary provision of the program, Part A, concerns hospital visits. It covers both acute care facilities and nursing homes.

You don’t normally have to pay a premium for coverage. But to qualify, you have to previously pay into the system by working for at least ten years.

However, you can still be eligible for part A if you haven’t worked the full ten years. But you may have to pay a premium to offset costs.

Even though Part A covers hospitalization, you still have to pay large deductibles and copayments. There are also daily charges for extended hospital stays.

Medicare Part B

Part B has to do with outpatient services. This is what’s covered:

  • Office visits
  • Lab tests
  • Medication that’s given at a doctor’s office
  • Physical therapy
  • Home health nursing
  • Occupational therapy
  • In-home health equipment

Although this list is extensive, keep in mind that it may not cover 100%. For example, you will be expected to kick in for some of the costs. This may include copays and deductibles.

While enrolled in Part B, you will also be expected to pay a monthly premium. The amount is based on median income levels. But if you make more than that, you will be expected to pay a higher premium.

Medicare Part C

One of the biggest problems with Medicare is overbilling. That is mainly why we now have Part C, which is the Medicare Advantage plan.

Part C is optional and covers everything that is already in A and B. But instead of the government providing benefits, the plan reroutes them through private insurance companies.

The upside to being under a Medicare Advantage plan is that the premiums and copayments are usually less than with Original Medicare. Also, the coverage is typically better since everything goes through a private company.

Medicare Part D

This optional plan covers prescription drugs only from a pharmacy. It does not include medications given in doctors’ offices or hospitals. However, those provisions are covered under Parts A and B. If you have a part C advantage plan, part D is usually bundled in, and then it is not optional.

Keep in mind that part D is only offered through private insurance companies. The nice thing is, you can combine your Part D prescription coverage with a Medicare Advantage plan. This option potentially could save you a lot of money.

Supplemental plans

Parts A and B are referred to collectively as “Original Medicare.” They both contain out-of-pocket costs such as deductibles and copays. And since there is no cap on those expenses, retirees often purchase Medicare supplemental plans.

Private insurance companies provide these policies. Their primary advantage is that they close the cost gaps not covered by original Medicare.

One of the significant benefits of a supplemental plan is freedom of choice. This means you are allowed to see any doctor or specialist you want. Also, you can visit any hospital of your choosing.

As long as your health care provider accepts Medicaid, you are automatically covered by the supplemental insurance.

How it works is, your doctor or other provider bills Medicare directly. After Medicare pays for their portion, they bill the insurance company for the rest. Under federal guidelines, that insurance company has no choice but to cover those additional costs. 

Medicare pros and cons

There are some wonderful things about Medicare, but also some downsides. Here are a few of the pros and cons:

Pros

  • Good insurance coverage for those over 65
  • Fairly flexible, especially with the different advantage plans
  • Covers a wide range of health conditions
  • Has an excellent prescription medication option

Cons

  • Very complicated and difficult to understand
  • Premiums, copayments, and deductibles can be very high
  • No ceiling on out-of-pocket costs
  • Does not cover long-term care

Medicaid overview

Medicaid is a federal-state assistance program designed to provide health care for those with lower incomes and limited resources. Although there are no age restrictions, they may be factored in when deciding state eligibility requirements.

Medicaid boasts almost the same benefits as Medicare. Examples are:

  • Hospitalization
  • Doctor’s visits
  • Labs
  • X Rays
  • Prescription drugs

Because individual states administer Medicaid, benefits may vary widely depending on where you live. And it is usually not identified as Medicaid. Each state typically applies its unique name to the program.

Medicaid is the largest funding source for healthcare in the United States. The Affordable Care Act passed in 2010 has significantly added to the number of people eligible to receive Medicaid benefits in recent years.

Eligibility requirements

States set their income requirements based on a percentage of the federal poverty level. Your modified adjusted gross income usually determines the benefit level. Also, there are restrictions on the amount of real and personal assets you can have when applying for Medicaid.

Medicaid pros and cons

Medicaid helps a lot of lower-income people in the US. But there are also a few problems with the program. This is a list of the pros and cons:

Pros

  • Little or no cost to the recipient
  • Increases health coverage for those who otherwise can’t afford it
  • Financial security is improved for the recipient
  • Often covers services that Medicare doesn’t, such as dental and long-term care

Cons

  • May be difficult to qualify initially
  • Fewer doctors willing to accept Medicaid patients
  • Not transportable from state to state
  • Patient may lose eligibility due to increased income

Dual eligibility

You may be able to qualify for both Medicare and Medicaid at the same time. If that is the case, Medicaid will cover most costs incurred by Medicare Parts A and B. In other words, by having both plans, you could possibly have no out-of-pocket costs for your health care.

Not only that, you can often sign both insurances over to a Medicare advantage plan. The result would be dual coverage that would take care of almost all your healthcare costs. In some cases, you could also receive additional benefits such as transportation to scheduled doctor’s visits.

Final thoughts

According to a survey conducted in 2020 by the Commonwealth Fund, 43.4% of US adults ages 19 to 64 did not have adequate health insurance coverage. Unfortunately, there was no improvement from the previous study conducted in 2018.

Without Medicare and Medicaid, those statistics would be considerably worse. Both of those programs provide much-needed health coverage in the US. So, whatever plan you qualify for, you have the peace of mind knowing you will be taken care of.

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The Best Emergency Dentist Near Me

Emergency Dental Care

By now, life throwing curveballs at you should be expected. Sometimes, these curveballs can come in the form of dental emergencies. Some of them might just require several deep breaths and chill, while others might call for immediate dental care. The severity of the condition should be what helps you figure out your next move.

Here are some of the dental emergencies that require immediate professional care.

Table of Contents

1. Knocked-out Tooth

Once a tooth has been knocked out, carefully pick it up, ensuring that you only touch the top (crown). See to it that you do not touch the root. After that, rinse the tooth slowly without scrubbing it. You can try reinserting the tooth back into the gum. If this is not possible, take the tooth and place it in a milk container to raise the odds of survival as you wait to get help from the dentist.

When you get to the dentist, they will first numb the gum. If you had reinserted the tooth, they would check whether it is in its correct position by taking an X-ray. After putting it in position or confirming that it is well placed, the dentist will then splint the tooth to ensure that it is firm and in place. Splinting takes two weeks.

In some cases, you might not find the tooth. Several materials can be used to fill this space. They include dentures (a removable false tooth), a bridge (a permanent false tooth), or an implant (a screw (made of titanium) placed in the jaw bone).

2. Abscessed Tooth

An abscessed tooth infection develops from a pus pocket in the tooth. This can cause profound sensitivity to hot and cold, severe toothache, and even fever. Other brutal effects include swelling of the neck’s tender lymph nodes, face swellings, and bumps developing on the gum near the tooth.

Before you contact a dentist, it is recommended that you first rinse the mouth with salt mildly diluted in it. Doing this several times will help you ease the pain while drawing pus nearer to the surface.

When you get to your dentist, their treatment goal will be getting rid of this infection for good. To do so, they may:

  • Perform a root canal. This will help save your tooth as well as eliminate the infection. They will drill the tooth and remove the diseased pulp, draining off the abscess. The pulp chamber is then filled and sealed. To make the tooth even stronger (especially for a back tooth), they may cap it with a crown.
  • Incise the tooth and drain the abscess. A cut is made into the abscess for the pus to drain out. The area is then washed with saline water. In some cases, a small drain can be attached to keep the cut area open for drainage in case of more pus.
  • Remove the tooth. This will be done only if there is no hope of saving it.

3. A Chipped or Cracked Tooth

In case this happens, you are supposed first to clean the mouth with warm water. After that, you can then apply a cold compress on the outside side of the fractured to help reduce the swelling. Do not use numbing products or painkillers since they can cause damage to your gums. Instead, try easing the pain with acetaminophen as you wait to get medical attention.

If possible, try to look for the broken fragment and store it in milk. The dentist might be able to reattach the fragment using a particular type of glue. If you cannot find the fragment, don’t worry. The dentist can be able to use a tooth filling material and build it up. If the back tooth was part of the broken fragment, you might need a cap (also known as a crown).

4. Severe Toothache

You can use several home remedies to relieve pain and inflammatory such as:

  • Saltwater rinse
  • Garlic
  • Hydrogen peroxide rinse
  • Cold compress
  • Peppermint teabags
  • Vanilla extract

The dentist will first administer some pain medication before they examine your tooth. After that, they will explain the tooth problem and its extent, giving you the available options. The tooth might even be extracted.

5. Crown Coming Off

This happens to people who wear a temporary dental crown. As you wait for the medical attention, you can put a little amount of Vaseline on the back part of the crown to serve as a temporary bond as you head to the dentist.

Your dentist will then take it from here. After a comprehensive assessment, they will provide you with a replacement for the crown. If taken care of, the replacement should last for quite a long time.

Dental Medical Insurance

Oral and dental issues do not send application letters before they develop. They can catch you off guard at any time. When this happens, the dental insurance cover will provide you with the coverage you will need and cater to the expenses. This will help you save money and at the same time maintaining a healthy mouth.

Moreover, regular dental checkups help you identify problems as early as possible. They save you from severe damage that may require costlier procedures. Such visits can be covered by most dental plans, some requiring little additional costs.

Top 5 Dental Insurance Providers

Finding comprehensive dental insurance is essential. To get the best one for you, you must first consider your needs. Below is a list of the top dental insurance providers.

1. UnitedHealthOne Dental Insurance

UnitedHealthOne Dental Insurance is an insurance policy whose products are underwritten by the Golden Rule Insurance Company. It is an easy and affordable way to obtain dental cover for you and your family. It caters to minor dental work and preventive dental care. The annual maximum cover ranges from $1000 to $1500. All plans have a $50 deduction. One of its most significant advantages is the fact that it has an extensive network of participating dentists. However, the policy is not available in all states and also does not cover orthodontic care.

2. Delta Dental Insurance

Delta Dental Insurance has been providing its services since 1954. Offering both HMO and PPO plans, the insurance has more than 140,000 participating dentists. All their claims are managed online. Their budget-friendly plans offer PPO discounts and preventive care in all the states and other US territories. Its only disadvantage is that you cannot get all the coverage options in every state.

3. Cigna Dental Insurance

Other than dental insurance, Cigna Dental Insurance also provides life, health, and disability insurances. It has received several positive ratings from popular insurance rating organizations. It even has a mobile application that makes it easy to find dentists near you. Its network providers automatically handle claims, easing off the burden of submitting them. With over 70,000 dentists in the network, the policy covers x rays, dental cleanings, and routine examinations. However, it does not cover as much of the dental costs as other covers do. Also, there is no coverage in several states.

4. Humana Dental Insurance

Humana Dental Insurance has plans purchasable both individually or through your employer’s health care program. You can choose your own dentists, and there is no co-pay whatsoever. It offers PPO and DHMO plans. Its website offers adjustable coverage options and other helpful features. When you get a Humana dental cover, you have the chance to enjoy huge discounts on preventive care and dental procedures. However, not all plans it offers cover orthodontic expenses. The plans are also not available in all the states.

5. Ameritas Dental Insurance

Ameritas Dental Insurance is a branch of one of the oldest insurance companies in the country, Ameritas Life Insurance Companies. Its greatest strength (and the reason why most people consider it) is its excellent customer service. With no enrolment fees, those covered by Ameritas have attractive discounts availed for them. You can even roll over some of the unused coverage to the following policy year. It offers up to a $2000 maximum cover annually. Its dental network provides more than 400,000 access points all countrywide. However, the insurance is not suitable for those in need of just basic coverage. They may be better off with out-of-pocket payments.

Is Dental Insurance Really Worth it?

The worthiness of dental insurance greatly depends on your personal preferences and your financial position. You may not have any access to employer-sponsored dental insurance. If you visit a dentist regularly for small appointments and rarely get additional treatments, then you will be well off without insurance coverage. If you need a lot of work done on your teeth, dental insurance won’t cover so much, and you might end up incurring substantial additional costs.

If your employer provides dental coverage for a few dollar deductions every month, then the cover is probably worth it. Moreover, families that have older members and children should also consider getting a cover. This is because such people tend to need dental work frequently compared to others.

With all these caveats, it might seem like a dilemma whether or not to buy an insurance policy. The best thing to do is evaluate your status and choose the right one for you.

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Efforts to Expand Dental Services for Low-Income People

Poor oral health among low-income people is gaining attention as a significant health care problem. Key barriers to dental services include low rates of dental insurance coverage, limited dental benefits available through public insurance programs, and a lack of dentists willing to serve low-income patients, according to findings from the Center for Studying Health System Change’s (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Communities are attempting to provide more dental services to low-income residents. Along with state efforts to increase dentists’ participation in Medicaid and the State Children’s Health Insurance Program (SCHIP), hospitals, community health centers, health departments, dental schools and others are working to expand dental services, with some focusing on basic preventive services and others pursuing more comprehensive dental care. Many community efforts rely on increasing the number of dental professionals available to treat low-income people. Without additional involvement from the dental community and state and federal policy makers, however, many low-income people likely will continue to lack access to dental care and suffer the consequences.

Table of Contents

Low-Income People Lack Dental Coverage and Care

Recognition of the importance of oral health has grown since the U.S. Surgeon General’s 2000 report, which highlighted the prevalence of poor oral health among low-income groups and stressed that oral health is essential to overall health.1 There is an apparent linkage between some oral infections and several systemic medical diseases, including heart and lung disease, stroke, and premature births. Further, abscessed teeth can cause severe infections and even death, as exemplified in 2007 by the widely publicized case of Deamonte Driver, a Maryland boy who died from a tooth infection that spread to his brain.

Lack of dental care is the key contributor to oral health problems, with low-income people and some racial and ethnic minorities facing particular barriers to care. According to the Agency for Healthcare Research and Quality’s 2004 Medical Expenditure Panel Survey (MEPS), approximately 40 percent of people living in poverty—those with incomes at or below $21,200 for a family of four in 2008—lacked dental coverage during the year, compared to approximately a quarter of people earning more than four times the poverty level. The 2005 MEPS indicates that approximately a quarter of people living in poverty had a dental visit during the year, compared with more than half of people with incomes above 400 percent of the poverty level. Likewise, approximately a quarter of Hispanics and blacks had a dental visit during the year, compared to almost half of whites.

HSC’s 2007 site visits to 12 communities (see Data Source) found that dental care is one of the most difficult health care services for low-income people to obtain, largely because of difficulties finding dentists who will accept public insurance or provide charity care. Additional barriers for low-income people may include a lack of awareness of the importance of dental health to overall health and perceptions that dental care is more of a luxury than a necessity.2 As a community health center respondent explained, “If you weren’t raised to get your teeth cleaned, you won’t do it.”

Given barriers to care, many low-income people do not receive preventive dental care or treatment for an oral health problem until an infection or other urgent condition develops. Diseased teeth are often extracted rather than restored.

State Medicaid and SCHIP Policy Affects Dental Coverage

State Medicaid and SCHIP policy plays a significant role in access to dental services at the community level. Although states are required to provide comprehensive dental coverage to children enrolled in Medicaid, dental coverage for children in SCHIP and for adult Medicaid enrollees is optional. While most states include some level of dental coverage through SCHIP, Medicaid coverage for adults varies greatly by state and is often limited to emergency services, with the comprehensiveness of coverage often fluctuating with state budgets. In 2006, when state budgets were relatively healthy, Florida started providing limited dental coverage for Medicaid adults and Massachusetts added two cleanings and exams a year in addition to emergency dental treatment coverage for adults.

Even when Medicaid and SCHIP provide dental coverage, low reimbursement rates often impede dentists’ participation. Although Michigan restored a previous cut in routine dental services for adults in 2006, dentists’ participation had declined significantly, leaving only 15 percent of dentists in the state accepting adult Medicaid patients.3 A Lansing respondent observed, “Patients thought they were going to get care, but they couldn’t because no one would see them.”

Increased payments that approach private insurance rates or dentists’ charges have contributed to an uptick in participation by dentists in some communities, including Little Rock, Phoenix and Syracuse. While New York’s 250 percent increase in dental reimbursement rates initially had little impact, it eventually prompted a few private dental practices in Syracuse to participate; in particular, a dental practice chain that focuses on treating Medicaid and SCHIP children opened two facilities in Syracuse. New Jersey—which traditionally has had among the lowest Medicaid payment rates in the nation—recently increased reimbursement for children’s dental services by 350 percent, putting Medicaid rates on par with private rates, although the impact of the change remains to be seen.

Along with raising reimbursement rates, simplifying administrative processes, such as claims processing, has been found to help improve dentists’ participation in Medicaid and SCHIP and access to care for enrollees.4 To do so, some Medicaid programs, such as Michigan’s Medicaid program for children, have contracted with commercial dental insurance plans.5 Yet, adequate payment remains key: Florida’s managed care pilot for children’s dental services resulted in a significant decline in dentists’ participation and utilization of care because of low capitated payments relative to the previous fee-for-service rates.6

Despite these changes, other challenges low-income people face, such as keeping appointments, reportedly contribute to some dentists’ reluctance to treat them.7 As a Syracuse respondent said, “The reimbursement increases were still not encouraging dentists to accept Medicaid patients. It turns out it was more of an issue of having the ‘unwashed’ in the waiting room, problems scheduling and noncompliant patients.”

Significant Gaps in the Dental Safety Net

Low-income patients who cannot find private-practice dentists to treat them often turn to safety net providers. However, the safety net for dental care is considerably less extensive than the safety net for medical care more broadly, and few dental providers focus on serving low-income people. Also, dental care traditionally has not been a core focus of general safety net providers—public and not-for-profit hospitals, community health centers, free clinics and local health departments—and their capacity is limited.

Hospital emergency departments (EDs) serve as de facto dental care providers. ED directors in Lansing, Miami and Seattle, in particular, reported high demand for dental services. The Emergency Medical Treatment and Labor Act (EMTALA) requires ED staff to screen and stabilize all patients, including those with dental conditions, although most EDs do not have the staff or equipment to provide dental services and are often limited to providing pain relief. However, some EDs in Syracuse, northern New Jersey and Boston benefit from having dental residents on call through their hospitals’ oral surgery or general practice dental residency programs.

Although some hospitals have dental clinics staffed by dental residents or volunteer dentists, services often are limited. As a Boston hospital CEO said, “There is infinite demand for dental services. Every Tuesday we have people lining up to have their teeth pulled.” Although some hospitals are expanding dental clinics, others question whether they should continue providing dental care, particularly as other types of residency programs and services generate more revenue. Seattle’s public hospital recently downsized its general dentistry clinic, after determining those services to be outside of the hospital’s core mission.8

Community Efforts to Expand Dental Services

Many communities are working to expand dental services for low-income people. These efforts range from providing preventive care—including cleanings, X-rays, fluoride treatment and sealants to prevent tooth decay—to filling cavities and providing other restorative services, and, in some cases, offering rehabilitative services, such as orthodontics and periodontics. Funding support for these services and participation from dental students and professionals are integral to these efforts.

Preventing dental problems. A number of communities provide preventive care and general dental education to schoolchildren, as such efforts are relatively low cost compared with the cost of treating future dental problems, and providing services at school removes some of the barriers associated with scheduling appointments. For example, students from a Cleveland dental school provide preventive care at local elementary schools, while the county health department in Miami operates a dental van that visits schools. In Syracuse, community advocates are working to re-establish the county’s school-based preventive dental program, which was discontinued after a cut in state funding.

Communities often rely on dental hygienists to support their preventive programs. Hygienists are less expensive and typically more available than dentists, in part because of recent expansions of training programs.9 A number of states now allow dental hygienists to provide certain preventive services to low-income people in public facilities without the direct supervision of a dentist. For instance, community activists in Arizona lobbied successfully to change licensure laws to allow hygienists to provide preventive treatments to low-income children without supervision.10

Yet, preventive programs need resources in place to treat dental problems identified during exams. Directors of the Cleveland school-based program have attempted to address this issue by partnering with local dental societies to generate a list of dentists willing to provide follow-up treatment.11 However, community programs that coordinate physicians and dentists willing to volunteer their services for low-income people typically have limited capacity. Through such a program in Little Rock, the wait for a dental appointment reportedly is several years. While advocates in some communities, such as Miami, propose advanced training for hygienists or other dental personnel to perform certain restorative treatments, state and national dental associations are largely opposed to such expansions in scope of practice, citing safety concerns.12

Providing comprehensive services. Federally qualified health centers (FQHCs) and other community clinics are increasingly offering dental services, including preventive, restorative, emergency and, in some cases, rehabilitative services. In particular, such health centers are key providers for racial and ethnic minorities and immigrants. With the support of federal grants, the volume of dental services provided by FQHCs grew 85 percent between 2000 and 2005; by 2006 approximately three-quarters of FQHCs provided preventive dental care.13 Health centers or community clinics in half of the 12 communities reported increasing capacity, for example, by opening new dental clinics, expanding clinic sessions and/or hiring new dental staff over the last few years. FQHCs receive enhanced Medicaid reimbursement, which helps generate the revenues to support these expansions.

However, health centers report that expansions to date do not approach the level of need, and waits for appointments remain long. Respondents in northern New Jersey and Seattle reported that the wait for an adult to see a dentist is often two to three months, even for extractions of diseased teeth. As a health center respondent from Indianapolis explained, “We have three [patient treatment chairs]. I could probably double those and still not have enough capacity.” Yet, federal dental expansion grants to FQHCs have waned in recent years.

Recruitment challenges also hinder additional expansion of dental capacity because health centers and community clinics often cannot offer competitive compensation. Although health centers receive dentists from the National Health Service Corps, which places dentists in underserved areas in exchange for student loan repayment, approximately 40 percent of urban health centers have reported it is very difficult to recruit dentists.14 Health centers in Little Rock, Syracuse and northern New Jersey reported significant problems recruiting dentists.

Developing community collaborations. Similar to their role in prevention efforts, dental schools are partnering with health centers to enhance training opportunities for students and increase dental services for low-income people. Training in community clinics typically enables students to treat more low-income patients than they would in dental school clinics.15 Health centers in Lansing, Indianapolis and Phoenix have such arrangements with local dental schools. Dental students have had a particular impact on access in Phoenix, where two new dental schools have an explicit focus on serving the community.

Although lacking a dental school in the area, Greenville recently created a dental program through a broad partnership with the technical college (which trains dental assistants and hygienists), the FQHC, a local hospital, and corporate and foundation support. The effort raised more than $1.6 million to care for 3,000 Medicaid and uninsured patients the first year. Care is provided through the FQHC’s fixed dental practice and a fully equipped mobile unit donated by the hospital, which brings dental professionals to churches, schools and other community sites. Students and faculty provide preventive services in exchange for training space, and three dentists employed by the health center provide restorative services. The health center’s enhanced Medicaid payments are expected to help sustain the program.

Implications

Community efforts to meet the dental service needs of low-income residents face an uphill battle because demand for services far exceeds available resources. Policy makers could consider a number of options to improve access to dental care through both public and private providers.

Additional state efforts to improve Medicaid and SCHIP payment rates and reimbursement processes could help expand the number of dentists willing to serve low-income people. Recent gains in dentists’ participation in some communities could erode if public payment rates are not adjusted as private fees increase.16 Yet, state spending on dental services is threatened by competing priorities and the current economic downturn and decline in tax revenue in many states. Policy makers also might examine whether targeted incentives to large dental practices that specialize in the particular needs of low-income patients—as seen in Syracuse—could help expand access in a cost-effective way.

Additional National Health Service Corps dentists, dental expansion grants for FQHCs and other federal efforts could help build community capacity. Prompted by the death of Deamonte Driver, several pieces of federal legislation aimed at improving dental access, particularly for children, are under consideration. One called “Deamonte’s Law” would attempt to increase the number of pediatric dentists and expand community health center dental capacity. Additional proposals include providing grants to states to improve Medicaid and SCHIP dental programs, offering tax credits to dentists who serve low-income children and establishing a working group of representatives from federal health and human service agencies to coordinate the use of resources and identify best practices regarding oral health programs.

Collaboration among policy makers, safety net providers, national and state dental associations and dental schools could help address gaps in the dental workforce. For example, the Robert Wood Johnson Foundation and The California Endowment are funding an initiative to help dental schools recruit more minority and low-income students and to place more dental students and residents in community clinics.17 Further, the debate continues about the level of care hygienists should be allowed to provide without the supervision of a dentist and whether other non-dentist professionals could safely fill cavities and extract teeth; such training programs are developing in Minnesota and Alaska.18

In addition, the overall supply of dentists should be examined, since the number of practicing dentists has not kept pace with the growing population.19 Although the dental workforce is expected to expand with the development of several new dental schools—with some schools focusing on training students in the community—it is uncertain whether the supply of future dental graduates will meet the rising demand for dental care.20 Moreover, without incentives for new dentists to treat Medicaid and SCHIP enrollees and low-income uninsured people, it is unlikely that an increased supply of dentists will significantly improve access to dental care for these vulnerable groups.

Notes
1.U.S. Department of Health and Human Services (HHS), Oral Health in America: A Report of the Surgeon General, Rockville, Md. (2000).
2.Ibid.; Kelly, Susan E., et al., “Barriers to Care-Seeking for Children’s Oral Health Among Low-Income Caregivers,” American Journal of Public Health, Vol. 95, No. 8 (August 2005).
3.“Share of Michigan Dentists Who Accept Medicaid Drops,” The Michigan Daily (March 14, 2006).
4.Borchgrevink, Alison, Andrew Snyder and Shelly Gehshan, Increasing Access to Dental Care in Medicaid: Does Raising Provider Rates Work? Issue Brief, California HealthCare Foundation, Oakland, Calif. (March 2008).
5.Eklund, Stephen A., James L. Pittman and Sarah J. Clark, “Michigan Medicaid’s Healthy Kids Dental Program: An Assessment of the First 12 Months,” Journal of the American Dental Association, Vol. 134, No. 11 (November 2003).
6.Community Voices Miami, “Understanding the Impact of Florida’s Medicaid Pre-Paid Dental Pilot,” Oral Health Issue Brief No. 2, Miami, Fla. (August 2006).
7.U.S. Department of Health and Human Services (HHS), Office of the Inspector General. Children’s Dental Services Under Medicaid: Access and Utilization, San Francisco, Calif. (1996).
8.Song, Kyung M., “Harborview Scales Back Outpatient Dental Clinic,” The Seattle Times (Nov. 1, 2007).
9.American Dental Hygienists’ Association, “Access to Care Position Paper” (2001) www.adha.org/profissues/access_to_care.htm (Accessed Feb. 29, 2008).
10.Arizona State Dental Hygienists’ Association, “Achievements” (2006) www.asdha.org/page-21.aspx (Accessed Nov. 1, 2007).
11.Lalumandier, James A., and Kay F. Molkentin, “Establishing, Funding, and Sustaining a University Outreach Program in Oral Health,” Health Affairs, Vol. 23, No. 6 (November/December 2004).
12.Berenson, Alex, “Boom Times for Dentists, But Not for Teeth,” The New York Times (Oct. 11, 2007).
13.National Association of Community Health Centers, Health Center Fact Sheet (2006).
14.Rosenblatt, Roger A., et al., “Shortages of Medical Personnel at Community Health Centers: Implications for Planned Expansion,” Journal of the American Medical Association, Vol. 295, No. 9 (March 1, 2006).
15.Bailit, Howard, et al.,“Dental Safety Net: Current Capacity and Potential for Expansion,” Journal of the American Dental Association, Vol. 137, No. 6 (June 2006).
16.Borchgrevink (2008).
17.Pipeline, Profession & Practice: Community-Based Dental Education, Fact Sheet, www.dentalpipeline.org (Accessed April 23, 2008).
18.Berenson, Alex, “Dental Clinics, Meeting a Need With No Dentist,” The New York Times (April 28, 2008).
19.Berenson (Oct. 11, 2007).
20.Bailit, Howard, and Tryfon Beazoglou, “Financing Dental Care: Trends in Public and Private Expenditures for Dental Services,” The Dental Clinics of North America, Vol. 52, No. 2 (April 2008).
Data Source

Approximately every two years, HSC conducts site visits to 12 nationally representative metropolitan communities as part of the Community Tracking Study to interview health care leaders about the local health care market, how it has changed and the effect of those changes on people. The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. The sixth round of site visits was conducted between February and June 2007 with 453 interviews. This Issue Brief is based on responses from state Medicaid executives and other policy makers, community health centers, safety net hospital executives and emergency department directors, local health department officials, consumer advocates, and other knowledgeable market observers.

 
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Articles

Health Insurance Brokers

Insurance brokers play an important role in helping small employers find affordable health coverage for their workers and dependents. While there are costs for using brokers, an examination of the role of brokers in 12 nationally representative communities by the Center for Studying Health System Change (HSC) indicated that brokers provide valuable services to small firms, such as obtaining prices for coverage, explaining benefits to employees and problem solving for employers. In some markets, brokers also helped educate employers and employees about state policy initiatives to expand coverage. In contrast to the notion that brokers merely make insurance more costly, these findings suggest brokers can provide important benefits to small employers, plans and policy makers.

Table of Contents

The Role of Brokers

Health insurance brokers are acommon feature of the small group health insurance market. At least half of small firms (those with two to 50 workers1) obtain health
benefits through brokers or agents.2 In addition, most health plans view
brokers as an extension of their marketing efforts. Despite brokers’ prevalence,
their role often is unclear to those outside the health insurance industry.Yet, a better understanding of how these intermediaries interact with employers and health plans can help policy makers develop effective policies to expand insurance coverage for workers in small firms.

The cost of coverage is a major impediment for small employers.3
Administrative expenses—including brokers’ commissions—contribute
to the high cost of insurance since small firms have fewer people over whom
to spread such fixed costs. Because brokers’ commissions can be a significant
component of administrative costs,4 policy makers
occasionally have proposed regulating brokers’ commissions to make insurance
more affordable. It is unclear, however, whether reducing or eliminating these
commissions would lower premiums because health plans probably would take over many of the services currently provided by brokers and pass along the cost to
employers.

During site visits to 12 communities in 2001-02 as part of the Community Tracking Study (CTS), researchers examined the costs and benefits of using brokers as well as brokers’ changing role in the small group market. Through interviews with brokers and representatives of health plans and small business associations, researchers explored the types of services brokers provide to health plans and small employers.

Understanding Commissions

Health plans reported that brokers are influential in directing business to them. In highly competitive insurance markets, such as Orange County, Calif., and Seattle, health plans reported that brokers provided more than 90 percent of business referrals from the small group market. Some insurers relied almost exclusively on brokers by distributing their small group market products through general agencies
(see box). Even in less competitive markets, brokers often had a significant role. For instance, although Anthem dominates the Indianapolis small group market, plan
respondents stressed that brokers are key to their distribution strategies.

Typically, brokers receive commissions from health plans in exchange for selling insurance products. Plans usually consider commissions to be part of fixed administrative costs for all small firms, so they build them into the premium. In that way, all small firms cross-subsidize the cost of using brokers even if they don’t use them, thus providing a powerful incentive for small firms to do so.

There was some variation across markets in the commissions reported by respondents, ranging from 2 percent to 8 percent. In two markets, state regulations influence commissions. New Jersey’s 1992 individual and small group market reforms attempted to make health insurance more affordable by requiring
health plans to pay at least 75 cents of every premium dollar on medical expenses.
In response, health plans cut commissions. In New York, small group market reform in 1993 limits health maintenance organizations’ (HMOs’) broker commissions to 4 percent of premiums.

In addition to variation across markets, commissions can vary significantly within a market, reflecting health plans’ differing business strategies and changes in market conditions. Plans attempting to expand market share tend to pay higher commission rates to encourage referrals. As an example, one small health plan in Indianapolis paid brokers a 10 percent commission, even though commissions there typically ranged from 6 percent to 8 percent. The underwriting cycle also
influences a plan’s commission rates, with plans paying higher rates during the phase of the cycle when they are trying to attract new business and lower rates during the following phase, when firms are seeking to restore profitability.

Some health plans find that paying brokers’ commissions does not fit into their business strategy. For example, only one health plan in the markets studied
chose not to pay commissions, relying instead on internal sales staff. But that
plan—Blue Cross Blue Shield of Central New York—dominates its market
and is able to maintain its market share. This is very much an exception among
commercial insurers. Traditionally, group and staff-model HMOs have not paid
commissions, but this is changing as well. For example, in an effort to be more
competitive with commercial insurers in the small group market and attract greater
market share, Kaiser Permanente in Orange County and Univera in Syracuse now
pay commissions.

Health plans occasionally use commission rates to discourage brokers from referring bad risks or market segments with above-average utilization of services, known as adverse selection. For example, some plans pay no or very small commissions for business sold to the smallest groups, which often have the highest potential for adverse selection. In Miami, health plans would not pay
commissions for groups with fewer than 10 people. This is counterintuitive because health plans usually decrease commissions as group size increases to reflect the lower cost of marketing to larger firms. This attempt to discourage business referrals based on the size of a group is in violation of the federal small group market reform, known as the Health Insurance Portability and Accountability Act
(HIPAA). The Centers for Medicare and Medicaid Services, which is charged with
 enforcing HIPAA, has condemned these practices and has encouraged states to take appropriate actions against such activities.5

Brokers’ Changing Role

Although nearly all observers reported that brokers were mainstays of their markets, advances in information technology could bring about changes. Small employers will have more opportunities to purchase insurance online, either through brokers who have established Internet sites or directly from health plans. This could result in greater competition between brokers and plans.

Some people have drawn a parallel to the airline industry, where the growth of online ticket sales led airlines to stop paying travel agent commissions. But purchasing health insurance is more complicated than buying a plane ticket: significant variations exist in provider networks, covered benefits and cost sharing. Sorting out these nuances and meeting with sales representatives from various plans has a high opportunity cost for employers. Many firms prefer to rely on brokers to work with insurers, explain the options and help make a decision.

Other forces that could change the role of brokers:
  • Market Conditions. Changing market conditions have resulted in the need for fewer brokers in some communities and more in others. Consolidation among health plans in Greenville, S.C., reduced the number of insurance options, thus lessening employers’ need for brokers. And in Seattle, plans have begun to contract selectively with the brokers who are most knowledgeable about plans’ product array and most effective in bringing more business to plans.

    In Orange County and Syracuse, in contrast, employers were increasing their use of brokers and demanding more account services, such as administration of Consolidated Omnibus Budget Reconciliation Act (COBRA) requirements for terminated employees wishing to continue health insurance coverage.

  • Public Sector Involvement. In some communities, brokers have begun to play an important role in educating employers and employees about public insurance programs. For example, in Syracuse, brokers have referred eligible families to Medicaid and the State Children’s Health Insurance Program. Although brokers are not paid for these efforts, this work generates goodwill with employers, who can direct their low-income employees to health insurance options for dependents.

    Attempts to exclude brokers from public initiatives have caused problems in some communities. Legislators in Florida and California sought to create purchasing cooperatives for small employers and bypass brokers to avoid paying commissions. Brokers’ strenuous protests, however, led Florida policy makers to establish them as the sole distribution outlet. California’s cooperative tried to educate small employers about the cost of using brokers by making commissions a separate line item on employers’ invoices, but abandoned this policy because of brokers’ hostility and small employers’ continued preference for using brokers’ services.
Despite some changes, brokers remain entrenched in the small group insurance market. While they provide useful benefits to small employers, these services, along with increasing costs for health care, new technology and pharmaceuticals, contribute to the high cost of health insurance in the small group market, causing some small firms to be priced out of offering health insurance. Policy makers often assume brokers simply add to the already high cost of health insurance. But this conventional wisdom may be too narrow: while brokers are an expense, they do provide important benefits to health plans and employers, and these relationships have the potential to be an asset in policy makers’ attempts to expand coverage.

FAQs: Understanding Brokers

 

What is a broker?

Brokers typically are independent agents who receive commissions from an insurer for selling insurance products. Brokers usually work with multiple insurers, while agents have an exclusive relationship with a single insurer. A general agency, also known as a wholesale distributor or broker’s broker, serves as an intermediary between brokers and insurers. The general agency distributes multiple insurers’ products and works directly with brokers.

Who uses brokers?

While brokers’ clients can range from individuals to very large firms, brokers most often work with employers with two to 50 employees.

How much does it cost to use a broker?

Health plans typically pay brokers’ commissions. Commission rates vary across and within markets. Rates within HSC’s 12 sites ranged from 2 percent to 8 percent and often are low-ered as group size increases. Plans usually build commissions into the premium rates charged to firms, regardless of whether a firm used a broker.

  1. Notes
    The Health Insurance Portability and Accountability Act (HIPAA) defines small firms as those with between two and 50 employees.
  2. Marquis, Susan M., and Stephen H. Long, “Who Helps Employers Design Their Health Insurance Benefits?” Health Affairs, Vol. 19, No.1 (January/February 2000).
  3. The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits: 2001 Annual Survey, The Henry J. Kaiser Foundation (2001).
  4. Hall, Mark A., “The Role of Independent Agents in the Success of Health Insurance Market Reforms,” Milbank Quarterly, Vol. 78, No.1 (March 2000).
  5. Correspondence dated July 14, 2000, to the National Association of Health Underwriters.