2014-2025 Form

Thanks for asking me, ‘Which country's healthcare system can be emulated in India? ‘.I was in the Govt service (Defence) for more than three decades before I entered the private health care. With experience in both the sectors, I think I am qualified to answer this question.Before I discuss which system is better for India, its better to start with a brief history of health care in India to give orientation and ground for appreciating the ground reality.The first medical institution in India was founded in 1664 by the British East India Company, and it stands today as the proud Govt General Hospital (GGH), Chennai. Surprisingly, this hospital is younger to Taj Mahal by about 30 years only.Govt General Hospital (GGH), Chennai. ( Source: Google)The first medical college in India was started in Calcutta (1835) followed by the Madras Medical College (1835).BTW, I want the readers to know that the 2nd oldest Eye hospital to establish in the world after London, is Eye Hospital, Chennai, and not in Germany or France or America!!!These two medical colleges-Calcutta and Madras- formed the mother colleges to provide instruction in modern medicine, and their alumni went on manning the future medical colleges established gradually in various cities across India over a period of time.In the hospitals attached to the medical colleges, treatment was always free and till the early sixties, higher specialty treatment was available only in the medical college hospitals. Mighty MGR was treated in Govt.General Hospital (GGH), Madras, when he was near fatally shot at. Medical treatment in private was confined to only OP cases.This brief introduction is meant to let the readers appreciate that even the rapacious colonial masters considered health care is the responsibility of the state. The policy of free treatment has been in continuation till now albeit in such a diluted fashion that now the health care in govt hospitals is considered a mere tokenism.It will be of interest for the readers to know that in British India, there were two classes of doctors- The Indian Medical Service( IMS) on par with the ICS in status with even higher remuneration, and the lower qualified licentiates. Dr. Ronald Ross of malarial Parasite cycle fame, the second to win the Nobel Prize (NL) in the category of Medicine and physiology (1902), belonged to the Indian Medical Service (IMS). ( We for some unfathomable reasons do not count him among the NLs from India though the Nobel committee records him from India, officially ( born in Almora).The Bhore Committee:Abhorred by the discriminating two types of quality in medical care, in 1945, the Bhore committee strongly recommended to abolish the licentiate system and bring in uniformity in medical education across the country such that the basic medical qualification for practice of modern medicine remains only MBBS. This committee also recommended primary health care centres and secondary care centres at the district headquarters, and various other reforms that paved the way for expansion of healthcare, medical colleges and district hospitals and various specialties immediate post-independence.Till 1975 the products of these institutions were treated on par with the British qualified doctors, and the doctors qualified before 1975 could straight away register with the General Medical Council (GMC) of great Britain without exam (PLAB) and could practice anywhere in the commonwealth. Following introduction of bridge courses to grant MBBS to the graduates of integrated system ( ayurvedic and other licentiates) and ever falling standards, the GMC derecognized Medical Council of India in 1975. Instead of improving the standards we retaliated by derecognising diplomas of Royal Colleges (FRCS & FRCP), the craze for which only increased after that.The Deterioration of Govt Hospitals:The high quality medical manpower thus produced also has a flip side. After the mid-sixties, when the medical institutions started showing signs of deterioration due to failure of administration to improve the infrastructure commensurate with time, and poorer remuneration of doctors ( purchase power of doctors salary reduced nearly 10 times by the sixties compared to 1917), these highly competent doctors found themselves not fitting into the dated hospitals and started to see greener pastures away from govt. service. Slowly but surely many ambitious and talented doctors started quitting the govt. service to enter lucrative private practice. This is the beginning of flourishing of private practice. It gradually started to acquire commercial tones from the early eighties while the government hospitals showed further decline in the scope and quality of medicare both due to lack of leadership at the helm and over crowding with patients who could not afford private care.Importance of InvestigationsWith rapid strides in medicare and introduction of new gadgets and investigations, the domain of clinical medicine has gradually receded back giving way to objective investigation dependent diagnosis and medicare. This is one of the causes for growing trust deficit between doctors and patients. But patients have to understand that early diagnosis is lifesaving often and it is sometimes intense investigation dependent. By the time the diagnosis of cancer stomach can be made clinically, the patient has passed beyond the stage of operability / cure. Only sophisticated investigations offer hope of early diagnosis and pave way for effective treatment.Since the answer is becoming too big, I will rather try to be more concise.The National Health Service (1948) in the UK is considered one of the ideal health care services on the earth. More patients have trust in the NHS doctors and the services than those who decry them.It offers stratified health care where a General Practitioner is the entry level medicare provider and the patient gets referred if the disease/ condition falls outside the GP’s expertise. A specialist cannot be approached by walking in, like in India. Patient has to patiently wait for his/ her turn for treatment/ procedure while emergencies are immediately attended. The waiting for knee replacement can run to months while it can be fixed in less than a week in India.Though the quality of care is high, this waiting time for procedures can be frustrating. ( One Indian family known to me returned back to India when the waiting for a D&C was told six months).The doctors in UK are well paid and fall into the 2nd highest social strata with such income after entrepreneurs and business houses. But these days many NHS doctors find the job highly stressful and I heard from friends in NHS expressing frustration at the working conditions due to ever increasing complexity of managing of patients in advanced years with multi co-morbid diseases, and lack of say in the matters that affect the doctors. Yet NHS continues to be popular. Private healthcare though exists in Britain, its not the main player and only the rich can afford.The American system is highly evolved in so far as providing treatment with cutting edge technology is concerned but quite costly to the point that patients sometimes choose to suffer the disease rather than go to a hospital. Without insurance, it’s difficult to bear the costs of American medical treatment. A profession of ‘billing’ has emerged from this complexity of American system, which, honestly I, an outsider, found too complex to bother to know about. The system is lawyer and litigation oriented. No prescription comes without extreme investigation. No one wants to miss any and that ‘you-never know-syndrome works to the hilt.I have seen their hospitals. Simply superbly maintained and meticulously managed. There is a lot to learn from their attention to the minutest detail.Now coming to India. When the govt has failed to introduce such facilities as required and in demand, the private sector has evolved to fill the vacuum and take care of the needs of population. Many good hospitals have come up to provide contemporary medicare at a fraction of what it costs abroad. Be it liver transplant or bone marrow transplant India has the expertise widely available, if I may say, more wider and accessible than the America. No frustratingly long waiting lists unlike the West. India even started attracting medical tourism.But Indian private care suffers from the following.Lack of institutionalism. With rare exceptions, a consultant in private works almost unsupervised/ unaudited unlike in govt sector where the treating physician cannot do things the way he wants. This lack of scrutiny or overseeing has given rise to suspicion and dubious practices.Though insurance is becoming popular, most families end up spending from pocket and the burden can be quite heavy and sometimes almost make the patients bankrupt following the treatment of major diseases. This is not the fault of doctors. Medical equipment are imported and costlier than they are abroad and their maintenance is very costly. Gadgets become obsolete in about a maximum of 5 years.Many patients do not buy insurance or budget for medical treatment like they do for education and weddings etc. leading to despair, and find the doctors soft target to attack to vent out their frustration. Its no solution at all.Reforms in Govt HospitalsThe existing Govt hospitals are to be expanded with establishment of more peripheral treatment centres especially cancer centres across the nation and augmenting the strength of specialist doctors with built in performance based incentives.With the existing salaries and work culture of staff, quality in govt hospitals is a mirage. Hire and fire system and delegation of powers to the deans with autonomy only will bring in changes.The existing system is highly bureaucratic and inefficient to give desired results. The deans with supporting young hospital management guys as administrators shall be given powers and made responsible for omissions and commissions. And the selection of deans shall be confined only to those with outstanding annual performance reports and not based on seniority alone.The private hospitals shall have some kind of peer audits and regulation to check if they are following established norms of practice. Ethical and transparent billing shall become the norm.We are evolving but the recent move by the govt to introduce bridge courses and allowing vaids of other systems to practice modern medicine is an ill-conceived move which will sure to destroy what little we have achieved in the medical care.Instead of exploring ways to increase the penetration of the available medical expertise through better infrastructure and performance based incentives, government is trying to tinker with the system, which can do irreparable damage to the health of profession itself. In the sixties integrated system guys were there who were later conferred MBBS and this half baked guys were the weakest links in the chain. I have known such guys and their below par competence.Accreditation of hospitals through agencies like NABL etc shall be made mandatory for all the corporate hospitals and NABH norms shall be applied for all the private and govt labs. Drug control shall be more stringent. These are the pressing needs not bridge courses to ayurvedic vaids and exempting exams to pathetically trained foreign qualified doctors who could not clear the national exam. Their pass rate at 7–13% speaks of volumes of their quality. Exempting them from examination amounts to promoting quackery on one side and killing the majesty of noble profession. If people have complaints about quality of doctors, to avoid them, they shall support quality measures.Politicians come and go but its the systems which remain in place and guie the society.How much it costs annually per head for free health care?It needs about 5–6 thousands per head per year to provide primary care for every individual in the society .And it can go up much higher if tertiary and quaternary treatments are added. The govt just doesn’t have that kind of money and for that matter no govt on earth can afford nearly 8 trillions rupees /annum to provide high quality free treatment for 1.3 billion people.My viewCulturally, Indians abhor long waiting and queuing up at the government clinics for minor ailments. Primary care for trivial ailments may be left as it is going on now- part private and part public with choice left to the patients.Secondary and tertiary care and trauma care require urgent attention. It shall be fully augmented at all levels in taluks and cities and govt shall ensure quality through new additional recruitment, implementing modern well established norms of management and adequate funding. While insurance base shall get expanded for those wanting private care.Quaternary care shall be such, part of the costs shall be borne by the beneficiary. If it has to be free, cost overruns will destroy the quality to make it dysfunctional. No govt can spend tens of lakhs of rupees per patient.

I can't say whether you would be contractually obligated. It's a very good idea to complete the survey and send it in as the carrier may put claims processing on hold for you until it receives your updated information. This means your providers won't get paid and when they don't get paid it's you they will be looking for.The insurance company sends these questionnaires because when someone has more than one form of insurance the different carriers take on roles — primary, secondary, tertiary, etc. The primary carrier pays first according to the terms of the policy. The secondary company will pay second, but they will only consider what's left after the primary pays.For example, let's say your ER visit was $2000. Your deductible is $1000 with the primary carrier and the primary insurance pays $1000.Your deductible with the secondary insurance is only $500. The secondary carrier is now looking at a bill for $1000. They pay $500.In the end, you paid $500, primary paid $1000, and secondary paid $500.If you only gave the provider information on your secondary insurance, they would be billed that while $2000 (as the ER wouldn't know about your other coverage). The secondary carrier, knowing they're second, will insist it's sent to the primary carrier for payment first.If they don't know there's a primary carrier, this becomes a very different financial situation for them — instead of $500, they pay $1500! That's your full bill less the $500 you pay out of pocket.Not knowing about the primary carrier just cost the secondary insurance an additional $1000.It's for this reason that they keep sending you questionnaires, and for this reason that they could hold off on processing your claims if you don't respond. In the end their goal is to save as much money as possible by making sure that they don't pay anything for which they aren't liable.

I was 16. 1991.I’d thought about it before, of course. My mom and grandmother were both devout Catholics and I’d been going to various Christian churches since birth.But I’d just recently renounced Christianity for myself.Why? I can’t find the answer I posted before, so I’ll just give a quick recap.I had a car accident on a Monday afternoon in January when I was taking a friend home from school. A kid decided to play chicken with my car. I’d seen him ahead, had covered my brakes, he’d looked my way, he’d looked the other way, he’d looked my way. I moved my foot back to the pedal - he saw me! There’s absolutely no way he could have missed me!But…he still ran. And by that point, it was too late.The bottom dropped out of my stomach. His head spiderwebbed my windshield, he performed a triple somersault on the hood of my car, and luckily my car had stopped by the time he hit the ground. Also luckily, this happened just outside a convenience store where many people saw the accident and backed up my belief that the kid had seen me.By Wednesday evening at youth group, the story had spread through the rumor mill to change from: I had hit a kid with my car, to I had killed a kid with my car, to I had just killed a kid, to I had had an abortion. I had no idea things had gone that far, so imagine my surprise when I arrived at youth group to get pulled aside by the youth pastor. He sat me down and started railing at me, telling me how evil I was for making such a decision without asking for his advice. After 10 minutes of his yelling, he asked me what I had to say for myself.I asked just one question: who had told him I’d had an abortion?After he tried to hem and haw, I demanded the answer, and he finally told me. I started laughing, then explained to him that while all 3 “good Christian girls” who told him of my misfortune had all already lost their virginity, I - his so-called “devil child” - was still a virgin. Then I got up and left, never to return to that church.That whole situation left a horrible taste in my mouth. Part of me was tempted to do everything opposite to what I’d learned in church because I was so pissed off at the hypocrisy of it all. Instead, I took the opportunity to determine what I believed about everything - not what a youth pastor believed, not what my parents believed, not what my friends believed, but what I believed.Some things were easy to figure out, others weren’t so easy. Abortion was something I had a hard time determining my feelings about.Until we watched the movie The Accused in my speech class at school.For those who haven’t seen the movie, a woman (played by Jodie Foster) is brutally gang raped in the back room of a bar. After watching the film and discussing it with my teacher and fellow classmates, my feelings on abortion were set.Never, ever, ever, should any woman be forced to do or have done something to her body that anyone but she decides. Period.I dare anyone to watch that movie and then consider what would have happened if she had gotten pregnant. Should she have been forced to keep the product of that rape inside her body for 9+ months? She was already forced to endure more than most people will ever experience. Should she have been forced to suffer beyond that?Never.Why do men get to have rights over their own bodies? Why do men get to make the decision on their own whether they wish to take or not? Why do men feel they have the right to disappear and not pay child support for the product of their sperm if they want to? It may not be legal, but they do it anyway.So why can’t women get the same autonomy over their own bodies? Why can’t women choose to take a morning after pill if they’re afraid they might conceive? And if they do conceive, why can’t they decide whether or not the parasite inside them lives or dies?That’s how I felt after I saw the move The Accused. I was angry. I was already angry after what I went through at church. The movie only exacerbated that anger.And ever since, there is nothing anyone can ever say to me to get me to change my mind.My body, my choice. Your body, your choice.

Your question confuses me a bit. What's missing is "WHY are the instructions displayed?" What makes them so important? More to the point, what makes them so important to the user?You say it's a simple form, but also say they must read the instructions before filling it out. If it's simple, what are all the instructions for? I haven't seen the form and already I'm confused.People will do things if they understand (and agree with) the purpose for doing them. If they don't understand the need for the instructions (e.g. because the form appears to be simple), you'll have a hard time getting users to read them (they won't see the need).My suggestion would be to take a step back from the design a bit and look at the form's purpose. If the instructions are to minimize data entry errors, look for ways in your design to do that and eliminate an instruction or two. For example, do real-time validation of things like zip codes, phone numbers, usernames, and anything else your web page can do.If the instructions are to educate the user on some specific process, look at the process to see if it can be made simpler or more obvious such that it doesn't need any explanation.Finally, don't forget user testing--ask some potential (or representative) users what they think works for them.

NOOOOOOO. You are talking to a military romance scammer. I received an email from the US Army that directly answers your question that is pasted below please keep reading.I believe you are the victim of a military Romance Scam whereas the person you are talking to is a foreign national posing as an American Soldier claiming to be stationed overseas on a peacekeeping mission. That's the key to the scam they always claim to be on a peacekeeping mission.Part of their scam is saying that they have no access to their money that their mission is highly dangerous.If your boyfriend girlfriend/future husband/wife is asking you to do the following or has exhibited this behavior, it is a most likely a scam:Moves to private messaging site immediately after meeting you on Facebook or SnapChat or Instagram or some dating or social media site. Often times they delete the site you met them on right after they asked you to move to a more private messaging siteProfesses love to you very quickly & seems to quote poems and song lyrics along with using their own sort of broken language, as they profess their love and devotion quickly. They also showed concern for your health and love for your family.Promises marriage as soon as he/she gets to state for leave that they asked you to pay for.They Requests money (wire transfers) and Amazon, iTune ,Verizon, etc gift cards, for medicine, religious practices, and leaves to come home, internet access, complete job assignments, help sick friend, get him out of trouble, or anything that sounds fishy.The military does provide all the soldier needs including food medical Care and transportation for leave. Trust me, I lived it, you are probably being scammed. I am just trying to show you examples that you are most likely being connned.Below is an email response I received after I sent an inquiry to the US government when I discovered I was scammed. I received this wonderful response back with lots of useful links on how to find and report your scammer. And how to learn more about Romance Scams.Right now you can also copy the picture he gave you and do a google image search and you will hopefully see the pictures of the real person he is impersonating. this doesn't always work and take some digging. if you find the real person you can direct message them and alert them that their image is being used for scamming.Good Luck to you and I'm sorry this may be happening to you. please continue reading the government response I received below it's very informative.   You have contacted an email that is monitored by the U.S. Army Criminal Investigation Command. Unfortunately, this is a common concern. We assure you there is never any reason to send money to anyone claiming to be a Soldier online. If you have only spoken with this person online, it is likely they are not a U.S. Soldier at all. If this is a suspected imposter social media profile, we urge you to report it to that platform as soon as possible. Please continue reading for more resources and answers to other frequently asked questions:  How to report an imposter Facebook profile: Caution-https://www.facebook.com/help/16... < Caution-https://www.facebook.com/help/16... >   Answers to frequently asked questions:  - Soldiers and their loved ones are not charged money so that the Soldier can go on leave.  - Soldiers are not charged money for secure communications or leave.  - Soldiers do not need permission to get married.  - Soldiers emails are in this format: john.doe.mil@mail.mil < Caution-mailto: john.doe.mil@mail.mil > anything ending in .us or .com is not an official email account.  - Soldiers have medical insurance, which pays for their medical costs when treated at civilian health care facilities worldwide – family and friends do not need to pay their medical expenses.  - Military aircraft are not used to transport Privately Owned Vehicles.  - Army financial offices are not used to help Soldiers buy or sell items of any kind.  - Soldiers deployed to Combat Zones do not need to solicit money from the public to feed or house themselves or their troops.  - Deployed Soldiers do not find large unclaimed sums of money and need your help to get that money out of the country.  Anyone who tells you one of the above-listed conditions/circumstances is true is likely posing as a Soldier and trying to steal money from you.  We would urge you to immediately cease all contact with this individual.  For more information on avoiding online scams and to report this crime, please see the following sites and articles:   This article may help clarify some of the tricks social media scammers try to use to take advantage of people: Caution-https://www.army.mil/article/61432/< Caution-https://www.army.mil/article/61432/>   CID advises vigilance against 'romance scams,' scammers impersonating Soldiers  Caution-https://www.army.mil/article/180749 < Caution-https://www.army.mil/article/180749 >   FBI Internet Crime Complaint Center: Caution-http://www.ic3.gov/default.aspx< Caution-http://www.ic3.gov/default.aspx>   U.S. Army investigators warn public against romance scams: Caution-https://www.army.mil/article/130...< Caution-https://www.army.mil/article/130...>   DOD warns troops, families to be cybercrime smart -Caution-http://www.army.mil/article/1450...< Caution-http://www.army.mil/article/1450...>   Use caution with social networking  Caution-https://www.army.mil/article/146...< Caution-https://www.army.mil/article/146...>    Please see our frequently asked questions section under scams and legal issues. Caution-http://www.army.mil/faq/ < Caution-http://www.army.mil/faq/ > or visit Caution-http://www.cid.army.mil/ < Caution-http://www.cid.army.mil/ >.  The challenge with most scams is determining if an individual is a legitimate member of the US Army. Based on the Privacy Act of 1974, we cannot provide this information. If concerned about a scam you may contact the Better Business Bureau (if it involves a solicitation for money), or local law enforcement. If you're involved in a Facebook or dating site scam, you are free to contact us direct; (571) 305-4056.   If you have a social security number, you can find information about Soldiers online at Caution-https://www.dmdc.osd.mil/appj/sc... < Caution-https://www.dmdc.osd.mil/appj/sc... > . While this is a free search, it does not help you locate a retiree, but it can tell you if the Soldier is active duty or not.  If more information is needed such as current duty station or location, you can contact the Commander Soldier's Records Data Center (SRDC) by phone or mail and they will help you locate individuals on active duty only, not retirees. There is a fee of $3.50 for businesses to use this service. The check or money order must be made out to the U.S. Treasury. It is not refundable. The address is:  Commander Soldier's Records Data Center (SRDC) 8899 East 56th Street Indianapolis, IN 46249-5301 Phone: 1-866-771-6357  In addition, it is not possible to remove social networking site profiles without legitimate proof of identity theft or a scam. If you suspect fraud on this site, take a screenshot of any advances for money or impersonations and report the account on the social networking platform immediately.  Please submit all information you have on this incident to Caution-www.ic3.gov < Caution-http://www.ic3.gov > (FBI website, Internet Criminal Complaint Center), immediately stop contact with the scammer (you are potentially providing them more information which can be used to scam you), and learn how to protect yourself against these scams at Caution-http://www.ftc.gov < Caution-http://www.ftc.gov > (Federal Trade Commission's website)

I am not a doctor and have no personal stake in the implication here.  However I have noticed some questionable activity and will happily report it here.Some doctors accept a great deal of "Favors" from drug detailers while others refuse to do so.  Perhaps there is a tendency for the ones who accept these favors to write more prescriptions for the drugs represented by the detailers.  I suspect so but have no evidence to support this suspicion.The biggest practice in this arena is where the drug detailer provides lunch for the entire staff of a doctor's office.  The supposed claim is this gives the detailer a chance to talk to the doctor and promote his products.  I can't imagine how providing lunch for receptionists, nurses, assistants and other doctor's office staff promotes drug sales unless it gets the doctor to write more prescriptions for the expensive drugs in question.In years past, I have benefited from this free lunch at a particular doctor's office.  Since I was in the waiting room when the detailer arrived with bags of food I was invited to eat.  That has now changed.  A new federal regulation requires everyone who eats a free lunch in this setting sign a form to acknowledge their boon.  That means patients and their families no longer get a free lunch like all the employees do.My wife's PCP has free lunch provided for his entire office three times per week.  He has prescribed a number of very expensive Branded medicines for her to the tune of $1300 per month now.  My PCP (who is the chief of medicine in a large practice) refuses to let any of this go on in her medical office.  She has written several prescriptions for me that total about $200 per month.  One of the prescriptions I use is which I decided to continue taking after some of its competitors went generic.  I'm sure my doctor would have been happy to write one of the generics for me when they became available.  She asked, I refused.  At the time I refused I knew was nearing the end of its patent protection and I chose not to switch to save money for a year or two.I don't think there is direct corruption taking place in doctor's offices to get more expensive prescriptions written.  However, there is at least the appearance of conflict of interest in some doctor's practice.  In the federal government the appearance of a conflict of interest is enough to generate an ethics violation.

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