408-854-1883 starts at $30 per hr home care

http://www.countyhealthrankings.org/app/new-york/2017/compare/additional?counties=06_067%2B41_067

via San Diego , CA vs Boulder, Colorado – 2017 health outcomes

San Diego is 10x more in population than Colorado with same ratio of female to male and same % of seniors and 3x more Hispanics and Asian. Both cities has same average household income and drug overdose rate.

http://www.countyhealthrankings.org/app/new-york/2017/compare/additional?counties=08_013%2006_073

Skills & Experience
– Experience working with an individual living with Alzheimer’s
– Experience with personal care and companion care
– Experience preparing and cooking meals
– Experience working in a facility a plus

Requirements
– Be on the Home Care Aide Registry of the California Department of Social Services – Need to register? We can help you!
– 2+ years of verifiable employment history
– Experience working with seniors and patients with dementia – family caregiving experience is acceptable
– Must be able to pass a background check – We conduct the most thorough criminal background checks in the industry
– Drug-free – You must pass a drug test
– Tuberculosis (TB) clearance required
– Able to lift 50 pounds
– Proof of work eligibility
– Valid driver license and clean driving record
– Reliable vehicle with current car registration and automobile insurance
– GED, high school diploma, or college degree
– Speak, understand, and write English fluently

Great pay, annual increases
$15.00 4hrs-8hrs shifts, $17.25 3hrs shifts
Paid Time Off
Holiday work paid at time and a half
Overtime after 8 hours
Double Time after 12hrs
Flexible hours
Medical, Dental, and Vision insurance
Pension plan

Critical Appraisal of Health Economic Evaluation Studies

Key areas for critical appraisal – 1. The question

We need to ask ourselves two questions about the question the economic evaluation study seeks to address:

a) Is the type of analysis used appropriate to the question?
b) What is the perspective of the analysis?

These questions are related as they determine the type of analysis which should have been performed and the type of costs and benefits which should be collected. Each question is broken down into several sub-questions, presented below.

1a) Is the type of analysis appropriate to the question asked?

Economic evaluation can be used to assess:

The best way of achieving a given goal within a given budget. This is a technical efficiency question that can be measured by cost-effectiveness analysis or cost-utility analysis.

Is it worthwhile achieving a given goal?

This is an allocative efficiency question that can be measured by cost-utility analysis or cost-benefit analysis.

The crucial point for appraisal is whether the correct methodology has been chosen for a specific question.

There are three basic types of economic evaluation methodology:

• cost-effectiveness analysis (CEA)
• cost-utility analysis (CUA)
• cost-benefit analysis (CBA)

Cost-effectiveness analysis (CEA)

CEA relates costs to a single clinical or natural measure of effectiveness; i.e., a unidimensional outcome, e.g., pain reduction, activities of daily living.

CEA is best suited to measuring technical efficiency as it is difficult to compare treatments with different outcomes.

CEA can sometimes be used to provide limited information on allocative efficiency through a ratio of extra cost to extra benefit produced (incremental cost-efficiency analysis).

Cost-utility analysis (CUA)

Cost-utility analysis relates costs to a multidimensional measure of effectiveness which takes into account the valuation of benefits; i.e., a measure of utility.

CUA can be used to measure technical efficiency.

CUA can be used for allocative efficiency but only within the health care sector where health care costs only are included.

Cost-benefit analysis (CBA)

CBA relates costs to a valuation of benefits in commensurate (having a common or equal unit of measure), usually monetary, terms.

CBA can be used to measure both technical and allocative efficiency questions. It can be measured either within the health care sector or across other sectors of the economy.

1b) What is the perspective of the analysis?

Perspective is important as it determines which costs and benefits are collected.

Possible perspectives that should be considered are:

• a specific provider or provider institution
• a patient or patient group
• a health care purchaser (or third party payer)
• society at large

As a general rule CEA and CUA require only health care costs to be collected.

CBA requires all costs and benefits to be collected, no matter on whom they fall.

US is number 1 in health care spending in 2001

OECD Health Data 2001

When you compare the U.S. health care system to that of other industrialized nations, you will see startling results not only in expenditures but also in outcomes. Data from OECD Health Data 2001gives us comparative health status information on its 30 member countries.

These data show that, in spite of ranking at the top of the list for health expenditures, the U.S. falls into the mid-ranges for some broad measures, such as life expectancy and infant mortality.

World Health Organization Report, 2000

Source: Annex Tables 5-10
World Health Report 2000, WHO

What does this table tell you?

See if you can select the correct answer before reading on

This table tells me that:

A. Oman spends more on health care than the United States per capita
B. The US spends more on health care per capita but ranks very low with respect to overall health system performance
C. Costa Rica has a worse overall health system performance than Chile
D. The World Health Organization doesn’t keep very good records of health expenditures and overall health system performance

The correct answer is B. The U.S. spends more on health care per capita – it is number 1 in spending – but ranks very low (37th) with respect to overall health system performance.

Current Population Reports

A Current Population Reports Special Study says it in a nutshell:

“…the United States outspends the world on medical care, but three-fourths of developed countries have better health measures”.

Source of Quotation: Population Profile of the United States 1999, Current Population Reports Special Study, March 2000.

It is important to remember that medical care is just one factor that determines health. Some of the others, such as heredity, lifestyle, and preferences – diet, exercise, use of tobacco and alcohol, to name a few – must also be taken into account.

Health care expenditures as percentage of GDP

Source: CMS. Office of the Actuary, National Health Statistics Group.

Rapid growth in the health spending share of GDP stabilized beginning in 1993. Note the sharp upward curve between 1980 and 1992.

Spending

Spending on health care services and products reached $1.3 trillion in 2000, which was up 6.9% from the previous year. This $1.3 trillion figure represents 13.2% of the U.S. Gross Domestic Product (GDP), or the total value of goods and services produced that year in the U.S.

Looking at this amount in the very broadest context over 13% of the total amount that was spent for all goods and services, or about 1 dollar in every 7, was allocated for health care purchases in 2000.

The $1.3 trillion also means that individuals spent $4,637.00 per capita in 2000 in their quest for “health”. This is well above what other industrialized nations spend. The U.S. ranking for per capita health expenditures consistently exceeds that of other OECD nations, and the rate of increase in per capita health expenditures is relatively high as well.

What are some factors that contribute to the rapidly escalating health expenditures?

Throughout the literature, several determinants are cited repeatedly: an aging population, an increased demand for and use of advanced technology, a decline in enrollment in restrictive, cost-containing health care plans, and rapid spending growth on prescription drugs.

In the U.S. health care is financed, or paid for, in a variety of ways. Individuals may pay directly for services received. Others may have health insurance coverage as a tax free benefit from their employment. Military personnel and their dependents, as well as veterans, are provided health care coverage through the federal government. Older Americans depend upon Medicare and low income mothers and children, as well as some disabled persons in the U.S., receive health care assistance through Medicaid. Children who might not otherwise receive medical attention may do so through the State Children’s Health Insurance Program (SCHIP).

Many of the employed are covered by employer provided health care insurance… traditional indemnity insurance or a managed care plan, such as a Health Maintenance Organization (HMO), Preferred Provider Organization, (PPO) or Point of Service Plan (POS) – which employers purchase as a group. Employees may or may not have had some input into the choice of that plan. Those with employer provided insurance are in good company, as the vast majority of Americans are covered by employment-based private insurance plans, 64% of the U.S. population, for example, in 2000.

An additional 24% of our population in the same year was covered by some type of government plan. The breakdown is as follows: Medicare, 13%; Medicaid, 10%, Military Health Insurance, 3%.

Many Americans are covered by more than one health insurance plan, and coverage between plans often overlaps. Among plans and programs there are many differences in the range of services covered, procedures followed, and payment provided. For our purposes today, it is probably not so important that we know all of these details, and you will find additional information on various types of insurance plans in the glossary.

From this brief description, however, one point is very clear. The health care financing system is not so much a system as it is a crazy-quilt of programs that, when pieced together, cover to some degree, the majority–but clearly not all—of the American people.