tag:theconversation.com,2011:/fr/topics/consumer-health-15733/articlesConsumer health – The Conversation2023-01-12T21:52:19Ztag:theconversation.com,2011:article/1960482023-01-12T21:52:19Z2023-01-12T21:52:19ZInflation bites: How rising food costs affect nutrition and health<figure><img src="https://images.theconversation.com/files/504330/original/file-20230112-70372-xy6ds0.JPG?ixlib=rb-1.1.0&rect=188%2C215%2C5721%2C3772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canadian food prices have soared over the past year. Higher food costs can affect nutrition decisions and ultimately health.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>Food for thought: rising grocery prices affect food choices and nutrition, and ultimately health, and even the health-care system.</p>
<p>As a result of inflation, the cost of food continues to soar, with data from <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1810000403">Statistics Canada</a> reporting the latest price changes of foods purchased from groceries stores and restaurants. </p>
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<a href="https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph of food prices" src="https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499588/original/file-20221207-8673-jo929u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Changes in food prices from September 2022 to October 2022.</span>
<span class="attribution"><a class="source" href="https://www150.statcan.gc.ca/n1/daily-quotidien/221116/cg-a004-png-eng.htm">(Statistics Canada)</a></span>
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<p>In September, Canada experienced its largest yearly increase in foods purchased from grocery stores or restaurants (10.3 per cent). Prices for food rose slightly less in October (10 per cent), but remain <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/221116/dq221116a-eng.htm">elevated</a>, with <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/221221/dq221221a-eng.htm?indid=3665-1&indgeo=0">November’s increase</a> coming in at 6.8 per cent.</p>
<p>In response to this rapid inflation, many Canadians took to social media, particularly <a href="https://www.narcity.com/tiktokers-are-getting-real-about-what-inflation-looks-like-in-canadian-grocery-stores-videos">TikTok</a>, to share how much grocery shopping is costing and what they are getting for their money. </p>
<p>Canada’s recent <a href="https://nationalpost.com/news/canada/lettuce-prices-in-canada">lettuce shortage</a> has resulted in price hikes for romaine and iceberg lettuce, with many grocery stores posting signs about the shortage and imposing purchase quantity limits, while restaurants have modified their offerings and altered their menus.</p>
<h2>Why are food prices so high?</h2>
<p>The COVID-19 pandemic and other global events continue to have worldwide consequences for health and the economy, with food prices being no exception. </p>
<p>Prices are driven up in <a href="https://www150.statcan.gc.ca/n1/pub/62f0014m/62f0014m2022014-eng.htm?utm_source=rddt&utm_medium=smo&utm_campaign=statcan-cpi-22-23">several ways</a>, including supply chain issues (things like processing, packaging and transportation), changes in consumer spending patterns, and previously mandated business closures forcing the redistribution of foods from restaurants to stores, as well as unfavourable growing weather conditions (things like heat waves, extreme rain/flooding, droughts and freezing).</p>
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<p>As health behaviour researchers, we believe that many Canadians will undoubtedly feel the additional financial pressure at the checkout line, and many will eat less nutritious and cheaper food options. </p>
<p>In Ottawa, the <a href="https://www.ottawapublichealth.ca/en/public-health-topics/food-insecurity.aspx#2022-Nutritious-Food-Basket">cost of eating nutritious food</a> for a single person was estimated at $392 per month, based on data collected from May to June 2022. For a family of four, the cost jumps to $1,088 per month. </p>
<p>Undoubtedly, low-income and fixed-income households will feel the biggest pinch (especially in one-person or single-parent households) and the <a href="https://doi.org/10.24095/hpcdp.42.10.04">short- and long-term health impact</a> could add to our <a href="https://www.ctvnews.ca/health/health-care-surpasses-inflation-as-top-national-issue-of-concern-nanos-1.6176739">crippling health-care system</a>.</p>
<h2>How do rising food costs impact your health?</h2>
<p>With the rising cost of food, many Canadians are experiencing insecure or limited access to food. This can have various effects on health, such as a decrease in <a href="https://doi.org/10.17269/s41997-021-00597-2">mental health</a>, <a href="https://doi.org/10.1371/journal.pone.0195962">increased risk of diabetes</a>, higher rates of autoimmune and infectious diseases, and <a href="https://doi.org/10.1186/s12889-021-11610-1">injuries</a>. </p>
<p>Research has shown that increased household food insecurity is strongly associated with greater strain on the <a href="https://doi.org/10.1503/cmaj.150234">health-care system</a>, with greater emergency room visits, longer hospital stays, more same-day surgeries, more reliance on physician services and home care services, and higher prescription drug use. </p>
<p>Older adults may also have health conditions with specific dietary requirements. With the increase in food prices, meeting these specific dietary needs may not be possible and can lead to additional health complications.</p>
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<img alt="A woman in a red apron placing canned goods on shelves" src="https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504328/original/file-20230112-27936-mwr9sg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Volunteers work at the Bathurst/Finch Community Food Space in Toronto. Inflation is putting a greater strain on food banks.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Alex Lupul</span></span>
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</figure>
<p>Furthermore, the higher cost of food is putting strain on <a href="https://www.cbc.ca/news/canada/food-bank-canada-usage-1.6631120">food banks</a> and school food programs, like the <a href="https://www.cbc.ca/news/canada/windsor/nutrition-von-school-meals-inflation-1.6568430">Ontario Student Nutrition Program</a>. School food programs provide <a href="https://doi.org/10.3148/cjdpr-2018-037">support to children</a> by helping ensure their stomachs are full while promoting healthful eating practices. </p>
<p>School food programs have been shown to be beneficial for better <a href="https://doi.org/10.1111/jhn.12407">academic outcomes</a> and <a href="https://www.healthyschoolfood.ca/the-evidence">overall health</a> in the short term, and food choices and behaviours in children are likely to <a href="https://doi.org/10.3390/nu9090990">continue into adulthood</a>, making childhood an essential time to have access to healthy foods. Suboptimal nutrition during this stage also may interfere with <a href="https://food-guide.canada.ca/en/applying-guidelines/nutrition-considerations-children-adolescents/">optimal growth and development</a>.</p>
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<h2>What can you do to save money?</h2>
<p>One of the most expensive things about food is food waste. According to <a href="https://www.secondharvest.ca/">Second Harvest</a>, Canada’s largest food rescue organization, the annual cost of avoidable food loss and waste in Canada was <a href="https://www.secondharvest.ca/getmedia/73121ee2-5693-40ec-b6cc-dba6ac9c6756/The-Avoidable-Crisis-of-Food-Waste-Roadmap.pdf">$1,766 per household</a>. </p>
<p>Making a meal plan for the week, with a shopping list before you go to the grocery store, is a great way to buy only what you need and ensure you use up what you’ve purchased. If you are only going to use half the produce for one meal, make sure you have a second recipe for later in the week to use it up.</p>
<p>There are several online applications, such as Flipp or Reebee, that can also help you shop sales or use coupons. Many food outlets allow price matching with other stores. Using loyalty program points is another option that can help pay for groceries. If you are a student or older adult, your local grocery store or retail drug store may offer discounts for shopping on a specific day of the week. </p>
<p>Lastly, eating with other people is not only associated with <a href="https://doi.org/10.1007/978-1-4614-7315-2_6">better diet quality</a> and <a href="https://www.cfp.ca/content/cfp/61/2/e96.full.pdf">psychosocial outcomes</a>, but may also reduce food costs, as families are only making one meal for all to enjoy.</p><img src="https://counter.theconversation.com/content/196048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rapid increases in food prices due to inflation mean many Canadians may be making different food choices. Here are the possible short- and long-term effects of that, and some ways to save money.Sarah Woodruff, Professor, Director of the Community Health, Enviornment, and Wellness Lab, University of WindsorPaige Coyne, PhD Candidate, Department of Kinesiology, University of WindsorSheldon Fetter, PhD Student, Department of Kinesiology, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1567972021-03-11T16:27:26Z2021-03-11T16:27:26ZWhy maize is causing trade tensions between Kenya and its neighbours<figure><img src="https://images.theconversation.com/files/389050/original/file-20210311-18-6mg6eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two men work their maize crop in Uganda's Kapchorwa district. </span> <span class="attribution"><span class="source">WALTER ASTRADA/AFP via Getty Images</span></span></figcaption></figure><p><em>There was confusion in the East African grain market this week after <a href="https://www.bloomberg.com/news/articles/2021-03-06/kenya-bans-corn-imports-effective-immediately-on-health-concerns">Kenya banned</a> maize imports from Tanzania and Uganda. The Agriculture and Food Authority said the reason for the ban was that levels of mycotoxins in the maize from the two countries were above safety limits. But in less than a week the Kenyan government <a href="https://www.bnnbloomberg.ca/kenya-backtracks-on-corn-import-ban-seeks-ratification-of-rules-1.1575394">appeared to backtrack</a> and <a href="https://www.businessdailyafrica.com/bd/markets/commodities/tough-kenya-lifts-tanzania-uganda-maize-imports-ban-3318540">announced</a> that it had asked its East African Community trading partners to pass sanitary and phytosanitary standards on farm produce before it reached Kenya. We asked Timothy Njagi Njeru, a development economist and research fellow with a special focus on agricultural development and innovation in sub-Saharan Africa, to shed light on events.</em></p>
<hr>
<h2>What’s the issue?</h2>
<p>Kenya initially imposed the ban because <a href="https://www.bloomberg.com/news/articles/2021-03-06/kenya-bans-corn-imports-effective-immediately-on-health-concerns">it said</a> grain from Tanzania and Uganda had high levels of mycotoxins. </p>
<p>Mycotoxins are poisonous compounds produced by certain types of moulds that grow on foodstuffs such as cereals and nuts in warm and humid conditions, either before or after harvest. Aflatoxins are among the most poisonous mycotoxins and can grow in the soil as well as on the foodstuffs. <a href="https://www.who.int/foodsafety/FSDigest_Aflatoxins_EN.pdf">Research</a> has shown that mycotoxins can damage DNA and cause cancer in animals. </p>
<p>Under the East African Community’s common market – which all three countries belong to – <a href="https://aflasafe.com/wp-content/uploads/pdf/TPP-8-Aflatoxin-Standards-for-Food.pdf">safe rules have been</a> which set standards for aflatoxins in maize. These vary from one jurisdiction to another. The East Africa Community’s standard is 10 parts per billion, the US’s is 20 parts per billion while the EU standard is four parts per billion. </p>
<p>In the East African Community, each country enforces the safety standard. In Kenya, the ministries of agriculture and health are mandated to enforce food safety standards. These ministries collaborate with the customs authority to police food imports. The Agriculture and Food Authority, under the Ministry of Agriculture, carries out checks to ascertain the levels of aflatoxins in the food supply system.</p>
<p>But the systems put in place for testing are flawed. For example, Kenya does not have a standard method for sampling and testing for aflatoxins. This is critical because aflatoxin levels can differ between grain collected from the same sack. This was illustrated a <a href="https://nation.africa/kenya/news/millers-query-kebs-standards-after-ban-on-5-maize-flour-brands-221880">few years back</a> when various government laboratories came under scrutiny over results showing different levels of aflatoxins for grain samples collected from an imported consignment. </p>
<p>Another challenge is that laboratories don’t all use the same protocols.</p>
<p>It gets murkier. Currently, important actors such as large grain milling companies conduct their own tests. </p>
<p>Standardising the sampling methodology would make the results more consistent. Credibility of the results enhances food safety and certainty for maize traders and consumers. </p>
<h2>What’s the significance of what’s happened?</h2>
<p>Events of the last few days has <a href="https://businessfocus.co.ug/kenyas-maize-ban-not-just-trade-issue-uganda-cancer-institute-boss/">raised awareness</a> about food safety standards in the region. Discerning maize consumers in Tanzania and Uganda are likely to take a greater interest in the aflatoxin standards and how they are applied to their domestic markets. </p>
<p>The developments are also significant for farmers in both countries, but more especially Tanzania. Farmers in Uganda mainly grow maize as a [cash crop](https://businessfocus.co.ug/ugandas-top-10-most-exported-crops-revealed/#:~:text=Ugandan%20farmers%20are%20currently%20counting,from%20US%2470.17m%20(Shs259.), and Kenya is a key market destination. In Tanzania, Kenya is a niche market offering better prices than <a href="https://ratin.net/assets/uploads/files/63683-quarterly-gha-cross-border-trade-bulletin-january-2021.pdf">domestic prices</a>. Any interruption in trade to Kenya would mean that farmers faced huge losses. </p>
<p>Third, this could potentially be a big win for food safety in Kenya. The government intervening to ensure food safety will increase awareness among producers and consumers. If sustained, Kenya will make progress on food safety in the food supply chains. </p>
<p>It is clear from Kenya’s statement <a href="https://www.businessdailyafrica.com/bd/markets/commodities/tough-kenya-lifts-tanzania-uganda-maize-imports-ban-3318540">lifting</a> the temporary ban that authorities intend to take a tough stance in policing maize imports. Maize importers will now be required to register, and incoming consignments must be accompanied by a certificate of conformity with aflatoxin levels. </p>
<p>Along with this, traders must provide details of their warehousing.</p>
<h2>Is imported maize a problem for Kenya from a food safety standpoint?</h2>
<p>The high levels of aflatoxins in imports from the region are associated with the fact that produce isn’t properly dried. For instance, Ugandan produce is regularly harvested and immediately transported to <a href="https://www.sciencedirect.com/science/article/pii/S0022474X19301377">Kenya from the farm</a>. Maize should be dried to 13% moisture level before storage. Some of the maize is thought to have up to 18% moisture content, implying that once the maize is harvested, it is immediately sold and shipped to Kenya from these countries. </p>
<p>Kenya relies on maize from Uganda and Tanzania to meet its demand each year. According to the <a href="https://kilimo.go.ke/food-balance-sheet/">Ministry of Agriculture’s data</a>, Kenya imported about 277,350 tons of maize (3.1 million 90kg bags) in 2020. About 95% of this came from Uganda and Tanzania. This year, it was estimated that the country would need to import similar amounts to be food secure. </p>
<p>Kenya’s maize production was about 3.8 million tons (42 million bags). Some of this also <a href="https://www.bbc.com/news/world-africa-50407159">contains aflatoxins</a>. The main reason for local contamination remains poor storage and transportation, as well as contamination from the soil, especially in the lower altitude areas (lower eastern region) that have humid and damp conditions. </p>
<p>For this reason, aflatoxins in the maize supply systems cannot be solely blamed on imports from the two countries. </p>
<p>But there’s a focus on imports now because Kenya is doing much more than its neighbours to combat aflatoxins in the food supply chain. Kenya already has a plant to develop <a href="https://aflasafe.com/aflasafe/what-is-aflasafe/">aflasafe</a>. Aflasafe is a fungus, in the same family as the aflatoxin-causing fungi, that is applied to plants and the soil and stops harmful fungi from taking hold of the grain. In addition, consumer awareness of the dangers of <a href="https://www.devex.com/news/kenyans-love-maize-but-aflatoxins-are-making-it-dangerous-96279">aflatoxins is higher in Kenya</a>. Similarly, the checks for aflatoxins in the food supply system are more regular in Kenya.</p><img src="https://counter.theconversation.com/content/156797/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Timothy Njagi Njeru does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The government intervening to ensure food safety will increase awareness among producers and consumers.Timothy Njagi Njeru, Research Fellow, Tegemeo Institute, Egerton UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1477092020-10-09T12:29:41Z2020-10-09T12:29:41ZWhat you – and doctors – should watch for if you have COVID-19<figure><img src="https://images.theconversation.com/files/362536/original/file-20201008-24-rlm5r3.jpg?ixlib=rb-1.1.0&rect=56%2C0%2C6196%2C4102&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">How does COVID-19 progress after you test positive?</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakNewYork/8424b4c5df8947328f5df5e705f4c6c2/">AP Photo/John Minchillo</a></span></figcaption></figure><p><em>Even though President Donald Trump is back at the White House following his hospitalization for COVID-19, people around the world are watching his health, in addition to that of a number of other politicians who <a href="https://abcnews.go.com/Politics/34-people-connected-white-house-previously-infected-coronavirus/story?id=73487381">have tested positive for the disease</a>. Infectious disease specialist and physician <a href="https://scholar.google.com/citations?user=OiXdBc8AAAAJ&hl=en&oi=ao">Kartikeya Cherabuddi</a>, who has treated COVID-19 patients, explains what medical doctors monitor and <a href="https://theconversation.com/trump-is-taking-the-latest-in-covid-19-treatments-heres-what-doctors-know-works-against-the-virus-147398">how they treat patients</a>, from the early days after an infection and the critical days that follow.</em></p>
<h2>Early symptoms and when to seek medical help</h2>
<p>Common early symptoms include those of the upper respiratory tract – sore throat, runny nose, cough – as well musculoskeletal symptoms, such as as muscle aches, joint pain and fatigue, as well as vomiting and additionally the loss of smell or taste. Fever is present in only a few patients. Many patients may have <a href="https://www.washingtonpost.com/health/2020/08/08/asymptomatic-coronavirus-covid/">very mild or no symptoms</a>. </p>
<p>As the illness progresses, doctors monitor the lungs for symptoms, such as shortness of breath, or other organ-related problems, such as chest pain of cardiac origin. They sometimes observe confusion, extreme fatigue and weakness in the elderly.</p>
<p>Difficulty breathing or the sensation of being out of breath, new confusion or the inability to stay awake, chest pressure or pain are reasons for being evaluated and for possible hospitalization. Monitoring body temperature is not as helpful for evaluating whether one needs to be hospitalized but a pulse oximeter, which measures your blood oxygen level, can be quite helpful. The higher your risk for severe disease, the lower the threshold should be for being evaluated. </p>
<p>In addition to knowing symptoms, it’s a good idea to have a COVID-19 plan for all members of your family. Here’s how to start:</p>
<ol>
<li>Where and how will you seek care?</li>
<li>Who will care for your dependents, including pets?</li>
<li>If living alone, who can check on you by phone?</li>
</ol>
<h2>Watching for a second wave after the first week</h2>
<p>Symptoms may worsen initially as they progress from the upper respiratory tract to the lungs. A <a href="https://www.washingtonpost.com/health/second-week-crash-is-time-of-peril-for-some-covid-19-patients/2020/04/29/3940fee2-8970-11ea-8ac1-bfb250876b7a_story.html">second wave of worsening symptoms</a> can then happen after the first week (often day 8 to 10) of illness, when the <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690">immune response goes into overdrive</a>.</p>
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<span class="attribution"><a class="source" href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm">Centers for Disease Control and Prevention</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>In high-risk individuals, it is important during this period after the first week to monitor the patient and to avoid a false sense of security.</p>
<p>Worsening shortness of breath, rapid breathing, the use of additional muscles to breathe, difficulty in getting sufficient oxygen and the appearance of being unwell are some of the signs practitioners watch for. A breathing rate above 30-per-minute or a low oxygen level with a new requirement for supplemental oxygen is classified as <a href="https://www.doi.org/10.1056/NEJMcp2009575">severe COVID-19</a>. </p>
<h2>Why the immune system response is critical</h2>
<p>During early onset of infection, a <a href="https://theconversation.com/what-does-survival-of-the-fittest-mean-in-the-coronavirus-pandemic-look-to-the-immune-system-137355">person’s immune system kicks in</a> with a broad, nonspecific response to the virus, which is <a href="http://www.doi.org/10.1126/scitranslmed.abd5487">especially effective in kids</a>. Immune system proteins called interferons appear to control the infection. The immune cells that attack seasonal coronaviruses which cause common colds do not appear to control the infection but may limit disease severity, duration or both. </p>
<p><a href="http://www.doi.org/10.1001/jama.2020.16656">From days 5 to 14 after infection</a>, a person’s adaptive immunity, which is specific and targeted to SARS-COV-2, takes over. It involves three components - antibodies, killer and helper T-cells. This response needs to be coordinated and controlled. This is often not the case in the elderly, and <a href="https://doi.org/10.1016/j.cell.2020.09.038">could explain the more severe illness</a> that is seen in older individuals. Antibodies can eliminate, or neutralize, the virus. </p>
<p>These immune cells and their products - cytokines, interleukins and interferons – can control infection but in severe cases <a href="https://theconversation.com/an-autoimmune-like-antibody-response-is-linked-with-severe-covid-19-146255">go out of control</a>. This produces a severe imbalance and causes the <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690">cytokine “storm”</a> in adults or the <a href="https://theconversation.com/mis-c-is-a-rare-but-dangerous-illness-striking-children-weeks-after-they-get-covid-19-heres-what-we-know-about-it-145673">multisystem inflammatory syndrome in children</a>.</p>
<p>Doctors carefully follow the patient’s symptoms, exam findings and clinical and laboratory parameters, such as blood tests that measure levels of specific proteins to determine if the patient’s immune system is over-reacting. Critical illness due to COVID-19 develops in 5% of all patients but occurs in <a href="https://doi.org/10.1016/j.eclinm.2020.100507">1 in 5</a> individuals requiring hospitalization.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Trump on the White House balcony" src="https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362666/original/file-20201009-23-xanbo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trump stood on the White House balcony after receiving hospital treatment for COVID-19.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakTrump/d79f6bcc01df47938907ae97dfcaa8d3/photo?boardId=7f1167ee48314b26a94cb1f0817262aa&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=2&currentItemNo=0">AP Photo/Alex Brandon</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Levels of treatment – mild to severe</h2>
<p>For people who test positive for COVID-19 but are asymptomatic or have mild symptoms, there is no proven, effective therapy. Getting a good night’s sleep and exercise and limiting anxiety are helpful. It is recommended that you maintain physical separation but stay in touch with family or friends. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30183-2/fulltext">Taking vitamin D could provide some benefit</a>, and has been shown in one <a href="https://www.bmj.com/content/356/bmj.i6583">metanalysis</a> of studies to protect against acute respiratory infections. Those with very low vitamin D levels benefited the most.</p>
<p>For people with mild to moderate symptoms, monitoring for any symptoms or signs of worsening in addition to pulse oximeter readings is recommended. Blood oxygen levels should be 94% or over in those with no underlying lung disease. If able, you can walk a little and repeat pulse oximetry, gradually increasing to 6 minutes of walking.</p>
<p>For people with severe disease who are hospitalized, there are a <a href="https://theconversation.com/trump-is-taking-the-latest-in-covid-19-treatments-heres-what-doctors-know-works-against-the-virus-147398">number of therapies available</a>: </p>
<ul>
<li><p>Antiviral agents. Remdesivir has been shown to <a href="https://www.doi.org/10.1056/NEJMoa2007764">decrease the duration of hospitalization</a>.</p></li>
<li><p>Immunosuppressive agents. <a href="https://theconversation.com/steroids-cut-covid-19-death-rates-but-not-for-everyone-heres-who-benefits-and-who-doesnt-145605">Corticosteroids</a>, such as dexamethasone have a broad effect in damping down the immune system and have been shown to <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2021436">reduce the number of deaths</a> from COVID-19 if oxygen is required.</p></li>
<li><p>Oxygen. It is administered to keep oxygen saturation above 94%.</p></li>
<li><p><a href="https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation">Medications to prevent blood clots</a>. These medications are given for preventing blood clots during hospitalization. Individual risk and mobility is considered by physicians when used post-discharge.</p></li>
<li><p><a href="https://theconversation.com/im-a-lung-doctor-testing-the-blood-plasma-from-covid-19-survivors-as-a-treatment-for-the-sick-a-century-old-idea-that-could-be-a-fast-track-to-treatment-144105">Convalescent plasma</a>. Plasma – the liquid portion of blood – from people who have had COVID-19 contains antibodies that can lessen the severity of an infection or prevent a current patient from getting ill. It is primarily available through clinical trials, which are needed to understand it better.</p></li>
<li><p>Monoclonal antibodies. These <a href="https://www.nih.gov/news-events/news-releases/clinical-trials-monoclonal-antibodies-prevent-covid-19-now-enrolling">laboratory-manufactured antibodies</a>, which are now going through clinical trials, could similarly lessen the severity of the disease or shorten the course of the illness.</p></li>
</ul>
<h2>Lingering effects and ‘long haulers’</h2>
<p>Doctors have known that viral infections, including measles, can cause long-term symptoms. Forty percent of survivors of severe acute respiratory syndrome, or SARS, which was also caused by a coronavirus, have reported having <a href="https://www.doi.org/10.1001/archinternmed.2009.384">residual effects even 3.5 years later</a>. </p>
<p><a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm">Persistent symptoms</a> for COVID-19 sufferers, termed “long haulers,” sometimes occur even in young adults and children with no underlying medical conditions. In a <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm">telephone survey</a> of symptomatic adults who were never hospitalized, 1 in 3 people overall and 1 in 5 among those aged 18 to 34 had not returned to their usual health 14 to 21 days after testing. Symptoms that persist include fatigue, cough, shortness of breath, loss of taste or smell, headache and body aches. Individuals with severe illness requiring hospitalization may take <a href="https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-long-term-symptoms.pdf?sfvrsn=5d3789a6_2">up to six weeks to recover</a>. </p>
<p>Blood clots in the lung, brain and other areas have been reported but with a wide variable range of estimates. <a href="https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation">Sicker patients and those with more underlying risk factors have a higher incidence</a>. These blood clots – in addition to viral and immune damage to the lungs, heart and brain – can lead to prolonged ill health, decreased mobility and mental issues. A practical and useful guide to <a href="https://apps.who.int/iris/bitstream/handle/10665/333287/WHO-EURO-2020-855-40590-54571-eng.pdf">rehabilitation self-management after COVID-19 related illness</a> is available from the World Health Organization. </p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p>
<p><a href="https://theconversation.com/how-covid-19-might-increase-risk-of-memory-loss-and-cognitive-decline-141940">Long-term mental effects</a> are an area of tremendous concern. Doctor offices should perform follow-up phone calls, establish post-COVID-19 clinics, and make <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html">mental health resources</a> available. Patients and family members can monitor breathing, exercise tolerance, swelling of limbs, body weight and mental activity, and be on the lookout for signs of depression.</p>
<p>For an individual patient, the course of illness and complications both immediate and long-term are unpredictable. They need to be closely monitored for two weeks following diagnosis for the second wave of worsening and for up to six weeks for recovery if hospitalized with severe illness.</p><img src="https://counter.theconversation.com/content/147709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kartikeya Cherabuddi received grant funding from National Institute of Health, Arrow International Inc. and the Bill & Melinda Gates Foundation. He is a member of the Infectious Diseases Society of America and a Fellow of the American college of Physicians. </span></em></p>With a COVID-19 outbreak in the White House, people are watching the health of President Trump and many others. A doctor explains the possible course for this unpredictable disease.Kartikeya Cherabuddi, Associate Professor of Medicine, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410522020-06-23T03:42:35Z2020-06-23T03:42:35ZEvery step you take: why Google’s plan to buy Fitbit has the ACCC’s pulse racing<figure><img src="https://images.theconversation.com/files/343130/original/file-20200622-75522-5r1j5p.jpg?ixlib=rb-1.1.0&rect=89%2C107%2C5901%2C3880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bangkok-thailand-october-06-2018-view-1381312625">Shutterstock</a></span></figcaption></figure><p>The Australian Competition and Consumer Commission (ACCC) has <a href="https://www.accc.gov.au/media-release/google%E2%80%99s-purchase-of-fitbit-raises-preliminary-competition-concerns">expressed concern</a> about Google’s <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">proposed acquisition</a> of fitness tracker company Fitbit. </p>
<p>The acquisition will let Google add years’ worth of Fitbit users’ data to its already unequalled consumer data collection. This could reduce competition in certain health services and other markets in Australia.</p>
<p>Google revealed its plans to acquire Fitbit Inc. for US$2.1 billion last November. But the deal will only go ahead if it gets clearance from competition regulators around the world. </p>
<p>While the ACCC is the first regulator globally to announce its concerns, the <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> and <a href="https://nypost.com/2020/04/03/feds-ramp-up-probe-of-2-1b-google-fitbit-deal-amid-privacy-worries/">US Department of Justice</a> are also evaluating the deal. Both will likely take an interest in the ACCC’s views, for which <a href="https://www.accc.gov.au/public-registers/mergers-registers/public-informal-merger-reviews/google-llc-proposed-acquisition-of-fitbit-inc">submissions are being accepted</a>.</p>
<h2>Collective concern is called for</h2>
<p>With more than <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">28 million people</a> using Fitbit wearable devices, many have <a href="https://www.theguardian.com/technology/2019/nov/05/fitbit-google-acquisition-health-data">raised concerns</a> about Google adding Fitbit’s sensitive data to its <a href="https://www.wired.com/story/google-tracks-you-privacy/">already extensive tracking</a> of consumers. </p>
<p>Google has left many <a href="https://www.wired.co.uk/article/google-buying-fitbit-health-data-privacy">questions unanswered</a> about how it would use the data. Consumers have reason to be sceptical about Google’s <a href="https://blog.google/products/hardware/agreement-with-fitbit">privacy promises</a>, and the competitive effects of the merger. </p>
<h2>Sharing your intimate details</h2>
<p><a href="https://www.fitbit.com/legal/privacy-policy#info-we-collect">Fitbit collects</a> highly personal information, including sleep patterns, heart rate, active minutes, height and weight, date of birth, food logs, mobile number, biography and precise location data. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343364/original/file-20200623-188911-1pn8l2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">According to estimates by Forbes, Fitbit co-founders James Park and Eric Friedman will each receive as much as US$150 million (before taxes) as a result of selling their shares in Fitbit.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/techcrunch/48843669166/in/photolist-2hq9za1-2hq9zds-2hq9z2R-2hq7Fg5-2hqatFu-2hqatD5-2hq7DuV-gK72e8-gK85aV-v4bND4-onq9rn-K5d9iM-yF6L5x-yF2fNJ-HckB8b-K2cXLo-y1zRxj-yYpUqp-yWBmV9-yF2h3Y-MQCAUc-o4aupd-w1yGoX-oksFeJ-o4aGe3-yXChSp-yF2gwC-yXChcg-o4auZ1-o4aME4-yYpTJz-oiCtsm-oiCsUs-JXiS9P-o4aaab-okC9V5-JXj216-okCuEq-y1Jqi2-okEevr-oknxmr-o4arwE-okE3Hz-K5d7Nn-okEiRR-okEhDF-onqgXp-o4bAMZ-onqayT-okC7rY">TechCrunch/Flickr</a></span>
</figcaption>
</figure>
<p>For those using Fitbit’s live coaching services, it also collects wellness plans and goals, calendar events, and communications with a coach. If you’re a woman using “female health tracking”, data can also include your periods, fertile times, ovulation days and health symptoms. </p>
<p>The ACCC regards Fitbit data as having “<a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique attributes</a>”, noting that datasets from other wearable devices are “not as voluminous, reliable or broad”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-accc-is-suing-google-over-tracking-users-heres-why-it-matters-126020">The ACCC is suing Google over tracking users. Here's why it matters</a>
</strong>
</em>
</p>
<hr>
<h2>Google’s privacy reassurances are not binding</h2>
<p>Last November, Google and Fitbit were quick to <a href="https://investor.fitbit.com/press/press-releases/press-release-details/2019/Fitbit-to-Be-Acquired-by-Google/default.aspx">reassure consumers</a> that “Fitbit health and wellness data will not be used for Google ads”. A Google spokesperson told The Conversation: </p>
<blockquote>
<p>Similar to our other products, with wearables, we will be transparent about the data we collect and why. And we do not sell personal information to anyone.</p>
</blockquote>
<p>However, the ACCC points out <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">Google is not bound</a> by its commitment to not use the data in its advertising businesses. As the competition watchdog’s <a href="https://www.accc.gov.au/media-release/digital-takeovers-transactions-may-harm-consumers">Chair Rod Sims</a> said:</p>
<blockquote>
<p>It is a stretch to believe any commitment Google makes in relation to Fitbit users’ data will still be in place five years from now.</p>
</blockquote>
<p>When Google acquired online advertising business DoubleClick, it reassured users it <a href="https://slate.com/technology/2016/10/google-changed-a-major-privacy-policy-and-no-one-really-noticed.html">would only combine personal data</a> from the two businesses if users opted into this combination. Eight years later, <a href="https://www.accc.gov.au/system/files/Digital%20platforms%20inquiry%20-%20final%20report.pdf">Google simply deleted this promise</a> from its privacy policy. </p>
<p>It’s also worth noting Google has not promised to refrain from using Fitbit data in its <em>non-advertising</em> businesses. This could include <a href="https://www.ft.com/content/50e1f042-06f3-11ea-a984-fbbacad9e7dd">health services</a> or, in future, <a href="https://www.ft.com/content/b7b3b08a-d4a3-11e9-8d46-8def889b4137">health or life insurance</a>. Google would not need to “sell” your data to use it for these commercial purposes.</p>
<h2>Google’s huge data advantage</h2>
<p>Google already has the most extensive collection of consumer data on the planet. This includes data from Google search, YouTube, Gmail, Google Maps, Google Nest, Android and Google devices – as well as consumer data collected from millions of third-party websites using Google’s services such as Google Analytics, Google Ads and reCAPTCHA. </p>
<p>The ACCC acknowledges Google already uses its pervasive data collection to create <a href="https://www.accc.gov.au/system/files/public-registers/documents/Google%20Fitbit%20-%20Statement%20of%20Issues%20-%2018%20June%202020.pdf">unique profiles of individual users</a>. It points out acquiring Fitbit would give Google “one of the largest and most detailed existing fitness and health datasets, as well as another avenue through which it can continue to gather consumer data”. </p>
<p>The ACCC is particularly concerned the proposed acquisition could substantially reduce competition between Fitbit, Google and others in “data-dependent health services” such as those supplying: </p>
<ul>
<li>tailored digital advice based on individual health signals to users of Fitbit and other wearables on how to improve their health or manage a medical condition</li>
<li>insights to insurance companies or employers wishing to compile risk profiles, reduce costs or enhance productivity </li>
<li>diagnostic tools for medical institutions and doctors to determine early indicators of chronic disease and</li>
<li>insights or raw data for health researchers. </li>
</ul>
<p>If Google acquires Fitbit’s user data, it could gain a significant advantage over other suppliers of these services and prevent them from accessing the dataset. </p>
<p>According to the ACCC, it could also have an incentive hinder rivals such as Apple, Samsung and Garmin, by removing their access to Google Maps, Google Play Store and Wear OS (a Google operating system for wearables).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/amazon-facebook-and-google-dont-need-to-spy-on-your-conversations-to-know-what-youre-talking-about-108792">Amazon, Facebook and Google don't need to spy on your conversations to know what you're talking about</a>
</strong>
</em>
</p>
<hr>
<h2>Entrenching Google’s power in digital advertising</h2>
<p>Google makes most of its annual revenue (more than US$100 billion) from online advertising services. Privacy advocates have <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3587239">criticised the ad tech industry</a>, including dominant players like Google and Facebook, for creating a “<a href="https://medium.com/clearcode/taming-the-wild-west-of-consumer-data-sharing-in-adtech-b3cab26adbe8">data free for all</a>” where consumers’ intimate information is exchanged between hundreds of companies engaged in targeted advertising.</p>
<p>The ACCC says it is concerned that by acquiring Fitbit’s datasets, Google could entrench its market power in certain ad tech markets. For example, it could “even more effectively target advertising to consumers with health-related issues”. </p>
<h2>What can the ACCC actually do about it?</h2>
<p>The ACCC plans to announce its final stance by mid-August on whether Google’s merger with Fitbit would contravene Australia’s competition legislation. If it decides the merger is likely to substantially lessen competition, it could seek orders from the Federal Court to prevent the merger.</p>
<p>But practically speaking, regulators will likely try to coordinate their response internationally, with the overall outcome decided in larger markets such as the United States and European Union. </p>
<p>The <a href="https://www.usnews.com/news/technology/articles/2020-06-16/eu-antitrust-regulators-set-july-20-deadline-for-google-fitbit-deal">European Commission</a> is expected to release its ruling in July. And past <a href="https://www.rferl.org/a/1096891.html">events indicate</a> the commission could impose conditions, or prevent the merger going ahead internationally – even if the US Department of Justice gives it the green light.</p><img src="https://counter.theconversation.com/content/141052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharine Kemp receives funding from The Allens Hub for Technology, Law and Innovation. She is a Member of the Advisory Board of the Future of Finance Initiative in India, the Centre for Law, Markets & Regulation and the Australian Privacy Foundation.</span></em></p>The watchdog has voiced concerns over the proposed US$2.1 billion merger, from which both users and Australian health services could lose out.Katharine Kemp, Senior Lecturer, Faculty of Law, UNSW, and Academic Lead, UNSW Grand Challenge on Trust, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1371562020-04-29T06:35:56Z2020-04-29T06:35:56ZShould I drop my private health insurance during the pandemic?<figure><img src="https://images.theconversation.com/files/331229/original/file-20200429-110734-1gx318o.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-nurses-station-modern-hospital-361328798">Shutterstock</a></span></figcaption></figure><p>Many Australians, especially those experiencing financial hardship due to COVID-19, are asking whether they can afford to keep their private health insurance.</p>
<p>Others don’t know if they should drop or downgrade their cover, especially if they cannot or don’t want to access services they’ve paid for.</p>
<p>Now consumer group Choice <a href="https://us4.campaign-archive.com/?u=270103a13e38b9f6643b82a8e&id=d9e5af4fa1">is recommending</a> <a href="https://www.abc.net.au/news/2020-04-24/calls-for-private-insurance-rebates-amid-coronavirus-pandemic/12178828">people think about</a> dropping extras cover, dropping or downgrading hospital cover and asking their insurance company for hardship considerations, which include waiving premiums or suspending their policy.</p>
<p>What options do you have? And what are the implications of dropping or downgrading your cover?</p>
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Read more:
<a href="https://theconversation.com/do-you-really-need-private-health-insurance-heres-what-you-need-to-know-before-deciding-93661">Do you really need private health insurance? Here's what you need to know before deciding</a>
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<h2>What services can I use?</h2>
<p>Our <a href="https://theconversation.com/do-you-really-need-private-health-insurance-heres-what-you-need-to-know-before-deciding-93661">research</a> shows people take out private health insurance because of shorter waiting times for elective surgery, choice of doctor or hospital, access to a private hospital room, and extras like dental and physiotherapy services.</p>
<p>Although some elective surgeries are due to <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/elective-surgery-restrictions-eased">resume this week</a>, it’s unclear how long it will take hospitals to clear the backlog, which surgeries will be performed and where. This raises questions about whether consumers will be able to access the benefits they value in having private health insurance. </p>
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Read more:
<a href="https://theconversation.com/what-elective-surgery-will-be-allowed-now-the-coronavirus-situation-has-improved-its-up-to-your-surgeon-or-hospital-137077">What elective surgery will be allowed now the coronavirus situation has improved? It's up to your surgeon or hospital</a>
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<p>While a key reason for taking out private health insurance is to avoid waiting times, people may now have to <a href="https://theconversation.com/what-elective-surgery-will-be-allowed-now-the-coronavirus-situation-has-improved-its-up-to-your-surgeon-or-hospital-137077">wait</a> while hospitals and health care providers resume a staged approach to resuming elective surgery and general treatments impacted by the pandemic.</p>
<p>People may also be worried about whether they will receive the care they need if they have COVID-19. However, they should be assured that emergency treatment will be provided through the public system. Many private health insurance companies will also now <a href="https://www.moneymag.com.au/coronavirus-private-health-insurance">cover COVID-19 related treatments</a>. </p>
<h2>How are private insurers responding?</h2>
<p>Modelling by the <a href="https://www.tai.org.au/sites/default/files/P910%20Private%20eyes%E2%80%A6%2C%20hips%2C%20etc%20%5BWEB%5D.pdf">Australia Institute</a> shows private health insurers could make considerable savings due to a reduction in claims paid to, or on behalf of, consumers during the pandemic. </p>
<p>This is because services, such as elective surgery, and general treatments, such as dental services, are not available or are limited. And it recommends some of these savings should be passed on to policy holders.</p>
<p>Private health insurance companies have <a href="https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/">assured</a> consumers that any increase in premiums will be delayed by at least six months.</p>
<p>They have also said that some funds resulting from the cancellation of elective surgery or allied health services will be <a href="https://www.privatehealthcareaustralia.org.au/health-funds-committed-to-providing-financial-relief-for-members-impacted-by-covid-19/">returned to customers</a>. It isn’t clear, though, how this will be done and over what period. </p>
<h2>What options do I have?</h2>
<p>It’s not surprising if you’re confused about whether to keep, drop or downgrade your private health insurance.</p>
<p>Our research consistently shows consumers find changing private health cover <a href="https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493">confusing</a>. Increasing costs of premiums, value for money and difficulties understanding policies are <a href="https://theconversation.com/explainer-why-do-australians-have-private-health-insurance-38788">common concerns</a>. People aren’t certain what they need cover for, what is a reasonable price to pay, and how much difference there is between the public and private systems.</p>
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<strong>
Read more:
<a href="https://theconversation.com/confused-about-your-private-health-insurance-coverage-youre-not-alone-49493">Confused about your private health insurance coverage? You're not alone</a>
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<p>If you are thinking about downgrading your hospital cover or stopping extras cover, think about what services you may need in the future. </p>
<p>Remember that if you downgrade your hospital cover to a lower level of cover some services may be excluded (for instance, pregnancy). If you decide to increase your level of hospital cover in the future you may also need to re-serve waiting periods for those services excluded at the lower level of cover. </p>
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<a href="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331236/original/file-20200429-110757-1pgn73j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Lower levels of cover may exclude some services, such as pregnancy care, which may be relevant in the future.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-sitting-on-bench-background-150533705">Shutterstock</a></span>
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<p>If you drop your hospital cover and take it up again in the future, you may pay more due to the <a href="https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/lifetime_health_cover.htm">Lifetime health cover</a> loading (if you do not take private health insurance up again <a href="https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/lifetime_health_cover.htm">within 1,094 days</a> of dropping your cover).</p>
<p>Choice is also recommending people <a href="https://us4.campaign-archive.com/?u=270103a13e38b9f6643b82a8e&id=d9e5af4fa1">drop</a> their extras cover. But your decision about this will depend on the types of services you typically use. </p>
<p>If you decide to drop your extras cover, you may also be required to <a href="https://www.ombudsman.gov.au/__data/assets/pdf_file/0017/35612/Waiting-periods-DL-Fyler-Web.pdf">re-serve waiting periods</a> if you take up extras again in the future. </p>
<p>This means you may need to wait two months for general dental services or physiotherapy, but 12 months for major dental procedures. However these waiting periods vary according to procedure and insurer. So to find out what waiting periods apply, ask your health fund. </p>
<p>If you are experiencing financial hardship you may be able to ask your fund to temporarily waive your premiums or suspend your policy. However, you won’t be covered while your health insurance is suspended.</p>
<h2>What happens after the coronavirus?</h2>
<p>The pandemic highlights issues with Australia’s health-care system, and how private health insurance operates and is funded. </p>
<p>There has been much critique of government policy encouraging Australians to take out private health insurance, and in particular the <a href="https://theconversation.com/private-health-insurance-rebates-dont-serve-their-purpose-lets-talk-about-scrapping-them-91061">subsidising of premiums</a> through the private health insurance rebate.</p>
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Read more:
<a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">Elective surgery's due to restart next week so now's the time to fix waiting lists once and for all</a>
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<p>At a time when more consumers are experiencing financial hardship they will question the value of their private health insurance even more than before. </p>
<p>There may be <a href="https://theconversation.com/elective-surgerys-due-to-restart-next-week-so-nows-the-time-to-fix-waiting-lists-once-and-for-all-136835">other ways</a> of providing health-care, including fixing waiting lists, that meet the needs of all Australians, while retaining the best aspects of both public and private care.</p>
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<p><em>As decisions about whether to change your private health insurance depend on your personal circumstances, please discuss your options and their implications with your health fund or read the fine print on policy documents.</em></p>
<p><em>For independent advice and consumer resources, see the government’s private health insurance <a href="https://www.privatehealth.gov.au/">website</a>, health department <a href="https://www.health.gov.au/resources/collections/private-health-insurance-reforms-consumer-resources">website</a> or consumer organisation websites such as <a href="https://chf.org.au/blog/gold-silver-bronze-making-health-insurance-easier-navigate">Consumers Health Forum of Australia</a> or <a href="https://www.choice.com.au/money/insurance/health">Choice</a>.</em></p><img src="https://counter.theconversation.com/content/137156/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Lewis receives funding from the Australian Research Council and the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Karen Willis receives funding from The Australian Research Council (ARC).</span></em></p>Drop, suspend, downgrade or keep? Many people are feeling the pinch and wondering if private heath insurance is worth keeping during the coronavirus pandemic. Here’s what to consider.Sophie Lewis, Senior Research Fellow, Centre for Social Research in Health, UNSW SydneyKaren Willis, Professor, Allied Health Research, Melbourne Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1276822020-02-20T12:18:35Z2020-02-20T12:18:35ZBoomers have a drug problem, but not the kind you might think<figure><img src="https://images.theconversation.com/files/314302/original/file-20200209-27552-16fh1on.jpg?ixlib=rb-1.1.0&rect=38%2C153%2C5092%2C3046&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some boomers are on multiple medications. Combinations of those drugs could have serious side effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-couple-in-front-of-lake-royalty-free-image/108354581?adppopup=true">Getty Images / Sporrer/Rupp</a></span></figcaption></figure><p><a href="https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html">Baby boomers</a> – that’s anyone born in the U.S. between 1946 and 1964 – are 20% of the population, more than 70 million Americans. Decades ago, many in that generation experimented with drugs that were both recreational and illegal. Although boomers may not be using those same drugs today, many are taking medications, often several of them. And even if those drugs are legal, there are still risks of interactions and side effects. </p>
<p>The taking of multiple medications is called <a href="https://doi.org/10.1186/s12877-017-0621-2">polypharmacy</a>, typically four or more at the same time. That includes prescriptions from doctors, over-the-counter medicines, supplements and herbs. Sometimes, polypharmacy can be dangerous.</p>
<p><a href="https://med.virginia.edu/faculty/faculty-listing/la2e/">I am a geriatrician</a>, one of <a href="https://health.usnews.com/health-news/patient-advice/articles/2015/04/21/doctor-shortage-who-will-take-care-of-the-elderly">only 7,500 in the U.S.</a> That’s not nearly enough to accommodate the <a href="https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html">surging number of elderly boomers</a> who will need medical care over the next two to three decades – or help in dealing with the potential problems of multiple drug use. </p>
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<img alt="" src="https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314322/original/file-20200209-27529-1yob4sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Make sure your doctor is regularly reviewing your medication list.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-taking-medicine-from-pill-organizer-royalty-free-image/505700181?adppopup=true">Getty Images / dszc</a></span>
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<h2>Reactions to medications can change over time</h2>
<p>We geriatricians know that polypharmacy isn’t always bad; multiple medications may be necessary. If you’ve had a heart attack, you might be on four medications or more – <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522">beta-blockers</a>, <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480">ACE inhibitors</a>, statins and aspirin, for instance. And that’s appropriate. </p>
<p>But about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/">half of older adults</a> take at least one medication that’s not necessary or no longer needed. Doctors need to periodically reevaluate to make sure each medication is still right for the patient and still the correct dose. During treatment, the patient’s weight may fluctuate, either up or down. Even if it stays the same, body composition might change; that occurs as people age. As a result, one may react differently to a drug. That can happen even with a medication a person has been on for years. </p>
<p><a href="https://doi.org/10.1517/14740338.2013.827660">Polypharmacy often means</a> higher health care costs and more drug interactions. Patients are more likely to miss medications or stop taking them altogether. Sometimes, physical activity diminshes; falls, cognitive impairment, malnourishment and urinary incontinence increase; there may be less ability to do daily tasks. Those on five or more medications have <a href="https://doi.org/10.1517/14740338.2013.827660">a much higher incidence </a> of having an ADE – an adverse drug event – compared to those using fewer meds. Making matters worse, the symptoms of polypharmacy <a href="https://doi.org/10.15256/joc.2011.1.4">are sometimes masked</a> and taken as signs of aging.</p>
<h2>Check the list</h2>
<p><a href="https://doi.org/10.1186/s12875-017-0642-0">Studies have suggested solutions</a>, with better coordination among care providers being one. Making the pharmacist an integral part of routine care is another. The increasing use of electronic patient records helps. So do smartphone apps, sometimes an easier way for patients and providers to connect. But so far, there’s no magic pill, and as researchers and clinicians investigate improvements, much of the burden remains on patients and their families. </p>
<p>There are steps you can take to stay safe, however. Regularly clean out the medicine cabinet and get rid of expired medicines or those you’re no longer taking. Either throw them away or ask your doctor or pharmacist about the best way to dispose of them. When seeing the doctor, bring in the meds you take and review each one in detail. Make certain you need to continue taking them all and verify the right dose.</p>
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<img alt="" src="https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314321/original/file-20200209-27519-1rijghf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Make sure you regularly check the expiration dates on your medications.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/medicine-pills-and-bottles-royalty-free-image/157310213?adppopup=true">Getty Images / dszc</a></span>
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<p>You can also check the PIMs list, also known as the <a href="https://doi.org/10.1111/jgs.15767">Beer’s List</a>. Published by the <a href="https://www.choosingwisely.org/societies/american-geriatrics-society">American Geriatric Society</a>, it’s an index of medications potentially harmful to the elderly. Some are linked to increased risks of side effects, and not a few are sold over-the-counter without prescription. </p>
<p>That includes medicines containing antihistamines like diphenhydramine, or Benadryl. In the elderly population, Benadryl carries an increased risk of dizziness, confusion and urinary retention. Medicines that are part of the NSAID family (nonsteroidal anti-inflammatory drugs) are also on the list. In some elderly patients, they can cause high blood pressure or kidney failure. Commonly used medicines in the NSAID family are those containing ibuprofen or naproxen. </p>
<p>Just because a medicine is on the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15767">Beer’s List</a> doesn’t mean your doctor was wrong to prescribe it, or that you should stop using it. Instead, use the medication with caution and discuss with your doctor to make sure you need it. Determine with your doctor the lowest useful dose, monitor for side effects, and speak up if you have any. </p>
<p><a href="https://www.choosingwisely.org/societies/american-geriatrics-society">As a geriatrician</a>, I see patients in an outpatient setting, either as their primary care provider or as a specialist consultant. We review medications at every visit: the list, the dose and how often the patient is taking it. A true and accurate medication list is the critical first step in geriatric care. </p>
<p>This is especially important during care transitions, such as when a patient is coming out of the hospital or nursing home. Particularly at that time, we find out if the patient is using the medication as prescribed, or taking it more frequently or less or not at all. Which leads to my final piece of advice: If you’ve strayed with your meds, one way or another, know that we doctors don’t judge or punish patients. Just tell us the truth. That’s all we want to hear. Then we can move forward together to find the best regimen for you. </p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/127682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone is affiliated with American Geriatrics Society.</span></em></p>As the boomers age, many will have medication issues. That can be compounded by the number of drugs they take, both prescription and over-the-counter.Laurie Archbald-Pannone, Associate Professor Medicine, Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1234492019-09-29T19:55:47Z2019-09-29T19:55:47ZHow to check if your mum or dad’s nursing home is up to scratch<figure><img src="https://images.theconversation.com/files/294244/original/file-20190925-51414-1f0h4w1.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C992%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If family members are in a nursing home, it's difficult to know if they're getting the care they need. Here are some ways to find out.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1022450005?size=medium_jpg">Nancy Beijersbergen/from www.shutterstock.com</a></span></figcaption></figure><p>If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.</p>
<p>For instance, there was <a href="https://www.abc.net.au/news/2019-09-12/bupas-aged-care-homes-failing-standards-across-australia/11501050">news in recent weeks</a> that 45 of 72 Bupa nursing homes in Australia had failed to meet all health and safety standards, with 22 putting residents at “serious risk”.</p>
<p>Then there are the <a href="https://www.abc.net.au/news/2019-02-22/first-fortnight-of-hearings-for-royal-commission-wrap-up/10837116">harrowing stories of neglect and abuse</a> coming from the <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care Quality and Safety</a>, which is due to release an interim report by the end of October.</p>
<p>So, how do you check if your loved one’s nursing home is really up to scratch? How do you interpret audit reports about residents’ health and safety? And how else could you find out if your mum or dad’s nursing home lives up to the promise of its marketing brochures?</p>
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<strong>
Read more:
<a href="https://theconversation.com/bupas-nursing-home-scandal-is-more-evidence-of-a-deep-crisis-in-regulation-123442">Bupa's nursing home scandal is more evidence of a deep crisis in regulation</a>
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<h2>Who keeps an eye on nursing home standards?</h2>
<p>Every nursing home in Australia receiving government funding is assessed and accredited by the <a href="https://www.agedcarequality.gov.au">Australian Aged Care Quality and Safety Commission</a>. Assessments are conducted every three years or more often if there are concerns. </p>
<p>Commission staff check if each nursing home meets eight <a href="https://www.agedcarequality.gov.au/sites/default/files/media/Aged%20Care%20Quality%20Standards.pdf">minimum standards</a>. These include whether residents are treated with respect, the nursing home is providing safe and effective clinical care, and staff have adequate qualifications and training to do their jobs.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-is-quality-in-aged-care-heres-what-studies-and-our-readers-say-104852">What is 'quality' in aged care? Here's what studies (and our readers) say</a>
</strong>
</em>
</p>
<hr>
<p>Commission auditors interview residents, families and staff; observe care; and review the facility’s documentation. Visits can be unannounced to get a better picture of what regular care is like. Auditors then use that information to write a site audit.</p>
<p>It takes about a month after a site audit for the commission to decide on the quality of care. Then there’s up to another month for the audit report to be posted online.</p>
<p>Posting the decision publicly can be delayed further if a nursing home asks for the decision to be reconsidered. We understand this often happens if a home receives a poor report.</p>
<h2>What is a bad report?</h2>
<p>When a home is judged as not meeting standards, the commission will decide how serious it believes these deficiencies are. In increasing order of seriousness, the report says if a home is:</p>
<p><strong>1. Not meeting standards</strong>. Nursing homes can be judged as not meeting one or more of the eight minimum aged care standards. Each standard has three to seven individual requirements. Nursing homes don’t have to meet all the individual requirements to meet the overall standard. The more standards or requirements a nursing home fails to meet, the poorer the care.</p>
<p><strong>2. Serious risk</strong>. If a nursing home is given a “serious risk” judgement, the quality of care has placed or may place the safety, health or well-being of a resident at serious risk. An example might be a home not having enough skilled staff, leading to clinical mistakes, such as the wrong medication administered often.</p>
<p><strong>3. Sanctions</strong>. Sanctions are imposed on homes when care places an immediate and severe risk to residents’ health, safety or well-being. This might be for multiple organisational problems (such as with clinical care, staffing, wounds not being cared for), leading to multiple poor outcomes (such as assault, avoidable illness, and the dangerous administration of medication). Homes can also be sanctioned if they do not fix continued non-compliance. </p>
<p>Families are notified in writing, and facilities must hold a meeting for residents and families to tell everyone what the problems are and how they will fix them by a certain date.</p>
<p>When a nursing home is sanctioned, it is penalised in several ways, depending on what was poor about the care:</p>
<ul>
<li>the home is not allowed to receive Commonwealth subsidies for any new resident for a set time (usually six months)</li>
</ul>
<p>and</p>
<ul>
<li>an adviser and/or administrator is appointed to the home to help it comply with its responsibilities</li>
</ul>
<p>and/or</p>
<ul>
<li>the home provides specified training to staff within a set time.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">Nearly 2 out of 3 nursing homes are understaffed. These 10 charts explain why aged care is in crisis</a>
</strong>
</em>
</p>
<hr>
<p>A home’s history of non-compliance, serious risk decisions and sanctions are archived online (see below for details). So it might be worth taking a look when choosing a nursing home, as well as checking on an existing one. </p>
<p><strong>4. Revoking accreditation status</strong>. If sanctions are imposed and there is no improvement, the commission can revoke a home’s accreditation status. This means a home cannot take new residents or receive government subsidies. Some of these homes reapply for accreditation, others <a href="https://www.abc.net.au/news/2019-07-11/gold-coast-earle-haven-retirement-village-shuts-homeless/11301050">shut down</a>.</p>
<h2>How do I find out? Looking online</h2>
<p>The most up-to-date information on nursing homes not meeting standards (non-compliance) and sanctions is through <a href="https://www.myagedcare.gov.au/non-compliance-checker">myagedcare’s non-compliance checker</a>. This allows you to see if an individual home has not met standards, is sanctioned currently or has been in the past. Some archived sanctions on the website go back to 2002.</p>
<p>However, the myagedcare website doesn’t list “serious risk” reports. For those, you have to go to the Aged Care Quality and Safety Commission’s <a href="https://agedcarequality.govcms.gov.au/monthly-register-serious-risk-decisions-residential-services">website</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293938/original/file-20190925-51452-v3cmhd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s lots of information online about nursing home standards and care, not all of it easy to understand.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mid-age-couple-working-home-on-200730065?src=m2fXbslTrNQEIMtQQD8SKA-1-25">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>You can also search the commission’s <a href="https://www.agedcarequality.gov.au/reports">website</a> for audit and consumer experience reports, which provide more detail on the quality of care.</p>
<p>Audit reports can be difficult to understand because their intended audience is aged care professionals, not the general public. Reports before July 2019 are on the 44 old aged care standards. Reports from July 2019 are on the new eight standards.</p>
<p><a href="https://www.agedcarequality.gov.au/consumers/consumer-experience-reports-residential-aged-care-services">Consumer experience reports</a> show what residents said about their care. That’s from whether staff followed-up when they raised an issue, to what they thought about the food. These reports are easier to follow.</p>
<h2>How do I find out? Other ways</h2>
<p>It can be hard for family to know if their expectations for care are reasonable, particularly when feelings of sadness and guilt colour those expectations. </p>
<p>So, it can help to consider the aged care standards when making your own decisions about whether the quality of care is good enough. </p>
<p>You can do this by observing what happens day to day. Do residents wait too long for attention, for instance, to be taken to the toilet? Do staff speak respectfully and kindly to residents? Are meals appetising and healthy? What happens when residents are distressed? Is there high staff turnover? </p>
<p>Does the nurse on duty know the detail of your loved one’s clinical needs, for instance, diet, illnesses or medications? Is the manager responsive when you raise issues? </p>
<p>You can also talk to other families about their experiences of care.</p>
<h2>What should I do next?</h2>
<p>If you find that your loved one’s home doesn’t meet standards or is sanctioned, here’s what to expect. </p>
<p>The commission gives the home a set period of time (usually three or six months) to improve care. Commission staff keep visiting the home until they are confident the home is meeting standards.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/294263/original/file-20190926-51452-v6bwy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Commission staff come back to the nursing home until they are confident standards are being met.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-nurse-working-rest-home-horizontal-334234871">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>You will probably want to visit regularly and keep an even more careful eye on your mum or dad’s care. Speak to the home or commission about any concerns.</p>
<p>You can ask your home’s management: </p>
<ul>
<li><p>about its plan to improve care</p></li>
<li><p>about staff changes and staff ratios — staff often leave or are asked to leave when there are sanctions and lots of new and agency staff are a challenge to providing quality care</p></li>
<li><p>for regular written updates and meetings including actions taken and the outcomes. This could be data on the home’s use of antipsychotic medications, and how often residents have falls, critical incidents or pressure ulcers.</p></li>
</ul>
<p>As a resident or nominated family member, you have <a href="https://www.agedcarequality.gov.au/consumers/consumer-rights#single%20charter%20of%20aged%20care%20rights">a right to information and to complain</a> about your loved one’s aged care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">So you're thinking of going into a nursing home? Here's what you'll have to pay for</a>
</strong>
</em>
</p>
<hr>
<h2>When should I consider switching to another home?</h2>
<p>The issue of whether to move a loved one to a new nursing home is a difficult one. It’s a personal decision involving weighing up the negative impacts you think the care is having with your own energy levels, <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">funds</a> and whether <a href="https://www.abc.net.au/life/questions-to-ask-when-choosing-an-aged-care-home-for-a-loved-one/10302590">you can find</a> a suitable new home.</p>
<p>Government reforms presume market forces <a href="https://www.smh.com.au/business/the-economy/how-market-forces-have-failed-the-nation-20180918-p504f1.html">will drive up the quality</a> of aged care. In the meantime, we hope the resources in this article will help you make a more informed decision about your loved one’s care.</p><img src="https://counter.theconversation.com/content/123449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low collaborates with and has received funding from multiple aged care organisations and sat on committees for the Australian Aged Care Quality Agency, the predecessor to the Aged Care Quality and Safety Commission. She is funded by an NHMRC Boosting Dementia Leadership Development Fellowship and has received funding from the NHMRC, Department of Health, NSW Health, Dementia Australia and other research funding organisations. </span></em></p>If you’ve read the headlines about poor standards in Australia’s nursing homes, it’s only natural to be concerned about your own family or friends in residential aged care.Lee-Fay Low, Associate Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213572019-09-12T11:06:09Z2019-09-12T11:06:09ZConcussions and children returning to school – what parents need to know<figure><img src="https://images.theconversation.com/files/291860/original/file-20190910-190021-7091p2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The level of knowledge around concussions among parents and school personnel is not as high as it should be.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adorable-cheerful-children-playing-soccer-ball-676528381?irgwc=1&utm_medium=Affiliate&utm_campaign=Pixabay%20GmbH&utm_source=44814&utm_term=https%3A%2F%2Fpixabay.com%2Fimages%2Fsearch%2Fchildren%2520playing%2F">LightField Studios/Shutterstock.com</a></span></figcaption></figure><p>“Jamal” is a 16-year-old boy who sustained a concussion in a skateboarding accident in July. He was diagnosed in the emergency room. Jamal initially had headaches, nausea and sensitivity to light and noise, but he appeared symptom-free within two weeks.</p>
<p>When Jamal returned to school in late August, he had difficulty waking up in the morning, paying attention in class and managing his assignments. His headaches returned. </p>
<p>But neither Jamal nor his parents traced these issues back to Jamal’s concussion, so no one told the school about his accident. His teachers – who did not know Jamal prior to the accident – saw him as unmotivated and moody. Jamal ended the first quarter with low grades, which his parents attributed to the more challenging curriculum. </p>
<p>This poor outcome could have been avoided with a few changes to the story and with better knowledge about concussions among school personnel and parents. Many policies and educational initiatives have helped target student athletes, but children who sustain concussions for other reasons – including accidents and overall play – may go unnoticed and untreated.</p>
<p>As a researcher in school psychology, <a href="https://udayton.edu/directory/education/edc/davies_susan.php">I</a> study how to help students thrive in school. I am particularly interested in the care they receive after concussions, and I have found this care to be inconsistent among both educators and medical personnel. While some injured student-athletes receive treatment in a sports clinic and are monitored by an athletic trainer, others receive little guidance on how to safely return to their normal activities. This lack of guidance sometimes causes parents to under- or over-restrict their child’s activity, both of which can prolong recovery. </p>
<h2>Collaborating with the school</h2>
<p><a href="https://www.cdc.gov/traumaticbraininjury/get_the_facts.html">Falls account for almost half</a> of the brain injury-related hospitalizations among children under 18. Preschool-age children are particularly prone to fall-related emergency department visits. <a href="https://www.cdc.gov/traumaticbraininjury/get_the_facts.html">Adolescents are also at relatively high risk</a> for brain injury-related hospitalizations, largely due to motor vehicle accidents. </p>
<p>Concussions can result in an array of symptoms with varying degrees of severity. Symptoms can be <a href="https://www.cdc.gov/traumaticbraininjury/symptoms.html">physical, cognitive, social-emotional and sleep-related</a>. While symptoms generally resolve within a few weeks, some may persist for months – or longer. Difficulties with headaches, concentration, memory and frustration are among the most common and persistent symptoms. </p>
<p>While doctors recommend that children who have sustained a concussion <a href="https://www.cdc.gov/traumaticbraininjury/symptoms.html">refrain from athletics</a> until they no longer have symptoms and have been cleared by a medical professional, they can <a href="https://www.cdc.gov/headsup/pdfs/schools/tbi_returning_to_school-a.pdf">return to school</a> as long as school personnel know how to manage their symptoms. This is not unlike a child returning to school with a broken arm. The teacher wouldn’t put the student in gym class or require them to write a lengthy essay, but they can still attend class and participate to the degree that the injury allows. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=956&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=956&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=956&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1202&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1202&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291861/original/file-20190910-190026-1qwzda5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1202&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents can coordinate with a person at school to track the progress of children at school after a concussion injury.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/thomashawk/2202278266/in/faves-41182236@N00/">Thomas Hawk/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Some schools have incorporated a <a href="https://concussions.brainsteps.net/about/brainsteps">team-based model</a> – including teachers, school nurses, school psychologists, athletic personnel and families – to help students return to the classroom safely after a concussion. Such teams typically assign a concussion team leader who serves as a care coordinator to facilitate communication among medical professionals, school personnel and families. This model can help ensure that all students are monitored upon return to school. </p>
<p>However, this type of coordinated care is not universal. Many <a href="https://ir.lib.uwo.ca/eei/vol26/iss1/1/">educators receive little or no training</a> on brain injuries, so teachers often miss students’ symptoms. And sometimes, the symptoms are not apparent until the child is faced with the demands of school. Returning to school is particularly difficult for children who were injured during the summer months and continue to suffer from symptoms well into the school year. </p>
<p>Generally speaking, parents need to become more familiar with concussion symptoms, including the fact that <a href="https://www.cdc.gov/headsup/pdfs/providers/facts_about_concussion_tbi-a.pdf">symptoms can return</a> with a change in activity. They can also facilitate their child’s transition back to school by signing a release of information so school personnel, such as the school nurse or school psychologist, can communicate directly with medical care providers. It’s also helpful to request that one person at the school serve as a care coordinator to make sure teachers, medical professionals, parents, the student and athletic personnel (if applicable) are all informed about a child’s ongoing symptoms and recovery strategies. </p>
<h2>Treating the invisible injury</h2>
<p>Because a concussion is an invisible injury, it can be difficult for teachers and parents – and even students themselves – to remember that environmental and academic adjustments are necessary during recovery. Further, the rate of recovery and the type of adjustments needed differ from child to child depending on <a href="https://bjsm.bmj.com/content/51/12/941">a variety of factors</a>, such as intensity of injury, the child’s age and preexisting issues. </p>
<p>Of key importance is the child’s <a href="https://www.pmr.theclinics.com/article/S1047-9651(11)00079-9/abstract">gradual and monitored return to activity</a>. This means that children recovering from concussions can return to school and some social activities, but should avoid physical or mental activities that may worsen symptoms. For example, use of technology – including computers, phones (for texting), video games, television and headphones (for listening to music) – can worsen symptoms and should be minimized when possible. </p>
<p><a href="http://orcas-sportsconc2.s3.amazonaws.com/files/e_academic_adjustments.pdf">Environmental and academic adjustments</a> should be put in place according to the child’s symptoms but should not be prolonged unnecessarily. For example, a child who is easily fatigued might take rest breaks in the nurse’s office; a child who no longer is sensitive to light does not need to wear sunglasses at school. Activity can gradually be increased as long as it does not cause symptoms to flare. </p>
<p>In addition to working with the school and medical professionals to implement appropriate accommodations, it is important that parents maintain documentation of the injury. The concussion should be reported on future medical forms, including those related to athletic participation. Since <a href="https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594">previous concussion is a risk factor</a> for future injury, a child needs to know about this risk factor and include his concussion history in self-reports of medical history. </p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/121357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Davies currently receives no external funding. Over the past five years, she has received funding through internal summer research grants from the University of Dayton, the Ohio Department of Public Safety (EMS Division), the Ohio Department of Health, and the Child Injury Action Group (Ohio). </span></em></p>Many educators receive little or no training in how to spot brain injuries resulting from a concussion. There are ways to improve collaboration.Susan Davies, Professor, School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/926632018-03-14T22:51:30Z2018-03-14T22:51:30ZDietary salt, the silent killer: How much is too much?<figure><img src="https://images.theconversation.com/files/210386/original/file-20180314-113458-bsasny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most Canadians eat at least double the daily adequate intake of sodium. And, shockingly, 93 per cent of children aged four to eight exceed Health Canada's Tolerable Upper Intake Level.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Salt is the universal flavour enhancer and we can’t seem to get enough of it. </p>
<p>While preparing food at home, or while buying prepared food from grocery stores and restaurants, salt tends to find its way onto our plates. </p>
<p>Does our love for salt come at a cost? How much salt is too much, and should we be concerned? These are the questions that not enough people are asking.</p>
<p>As a PhD candidate in human health and nutritional sciences at the University of Guelph, I study <a href="https://news.uoguelph.ca/2018/02/sweet-bitter-fat-new-u-g-study-reveals-impact-genetics-kids-snack/">how the genetics of taste affects taste perception, taste preference, dietary intake and metabolism</a> in the Guelph Family Health Study. </p>
<p>Part of this research examines how genetics can cause some people to be less sensitive to the taste of salt than others, leading them to prefer higher amounts in their food. </p>
<p>Identifying genetic markers can help us understand who may be more at risk of developing the adverse consequences of excessive salt intake, such as high blood pressure, the silent killer. </p>
<h2>Salt, heart disease and hypertension</h2>
<p>In 2012, <a href="https://www.canada.ca/en/public-health/services/diseases/heart-disease-heart-health.html">about 48,000 lives were claimed by heart disease</a>, the second leading cause of death in Canada. </p>
<p>One of the major <a href="https://www.statcan.gc.ca/pub/82-625-x/2015001/article/14184-eng.htm">silent risk factors for heart disease is high blood pressure or hypertension</a>. While it cannot be seen or felt, high blood pressure puts an enormous strain on blood vessels and weakens the body’s organs, including the heart and kidneys. </p>
<p>In 2014, almost one in five Canadian teens and adults reported being diagnosed with high blood pressure. With such a widespread influence on the health of Canadians, researchers and government have been working to identify and address this growing concern. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210175/original/file-20180313-30994-4b70c0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Genetics mean that some people need more salt on their tongues to taste it.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While the complex solution to lowering blood pressure in Canadians continues to evade us, it is well-known that we don’t need to look further than our dinner tables to find a culprit.</p>
<p>A certain amount of salt is essential to health. But most Canadians are consuming double and sometimes even triple the daily adequate intake (AI). </p>
<p>In fact, more than 85 per cent of men and between 60 to 80 per cent of women had sodium intakes exceeding 2,300 mg per day — <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/sodium.html">the Tolerable Upper Intake Level (UL) set by Health Canada</a> — according to the <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs.html">2004 Canadian Community Health Survey</a>. </p>
<h2>Children exceed tolerable salt levels</h2>
<p>In children aged one to three years and four to eight years, the ULs for sodium are 1,500 mg and 1,900 mg, respectively. </p>
<p>With these adjusted guidelines, even young children are not exempt from this striking pattern. Seventy-seven per cent of children aged one to three years and 93 per cent of children aged four to eight years exceed the UL for sodium, according to the 2004 Canadian Community Health Survey. </p>
<p>At these excessive levels, sodium in salt causes the kidneys to retain water in the blood vessels. </p>
<p>An increased amount of blood in the vessels puts pressure on the walls of the arteries, similar to how pumping gas into an inflating balloon puts pressure its walls. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210176/original/file-20180313-30986-ye0wic.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Seventy-seven per cent of sodium intake in Canada comes from commercially-prepared foods.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Over time and in combination with lifestyle factors, including an overall poor diet and lack of exercise, high blood pressure increases the risk of heart disease.</p>
<h2>A food industry fail</h2>
<p>We know Canadians are eating too much salt, but why is there so much in the diet? </p>
<p>While Canadians love the taste of salt in their food, intake of sodium is not mainly a problem in terms of how food is being prepared in the home. </p>
<p>Health Canada identified that commercially prepared foods account for 77 per cent of sodium intake in Canada. With the dependence of many Canadians on readily available prepared foods at grocery stores and restaurants, part of the solution must be for manufacturers to reduce the amount of sodium in their products. </p>
<p>In 2012, Health Canada published its <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/legislation-guidelines/guidance-documents/guidance-food-industry-reducing-sodium-processed-foods-2012.html">Guidance for the Food Industry on Reducing Sodium in Processed Foods</a>. This challenged the food industry to reduce sodium in a variety of food products, to targeted levels, by the end of 2016. </p>
<p>With this plan, Canadians would meet sodium targets without even having to reduce the amount of salt used at home. </p>
<p>These guidelines were mostly unmet by the food industry by the end of the program. Forty-eight per cent of food categories tested did not make any progress and 86 per cent of food categories did not meet their final sodium reduction goals. </p>
<h2>Consumer responsibility</h2>
<p>While it is tempting to fault the food industry entirely for this shortcoming, we must keep in mind that reducing sodium is more difficult in some products as it helps with food preservation and safety. </p>
<p>Consumer awareness and purchasing actions are also important for reducing sodium in food products. </p>
<p>This is a challenge to Canadians — to read nutrition labels on food products and make informed purchasing decisions. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210178/original/file-20180313-131584-d40pt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Genetics plays a role in the way that sodium is handled by the kidneys.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Are we ready to choose products with less sodium? With increased pressure on the food industry, perhaps we can improve blood pressure in Canadians.</p>
<h2>The genetics of taste</h2>
<p>Even if the goal of sodium reduction should be a collective effort by Canadians, not everyone responds to dietary sodium in the same way. </p>
<p>From the way that we taste salt to the way our kidneys process sodium, there are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491159/pdf/krcp-36-117.pdf">important differences in sodium sensitivity</a> between individuals, due in part to genetics. </p>
<p>The Heart and Stroke Foundation <a href="http://www.heartandstroke.ca/get-healthy/healthy-eating/reduce-salt">estimates that one in three people are sodium- sensitive</a>. </p>
<p>One important underlying reason for sodium sensitivity is in the way we taste salt. Genetics may lead some individuals to require more salt on their tongues to taste it; this is called low oral sensitivity. As a result, these individuals may need to consume higher amounts of salt in their food to taste it. </p>
<p>Genetics also plays a role in the way sodium is handled by the kidneys. For some unlucky people, genetic differences in kidney function lead to higher sodium retention and therefore higher water retention in the blood vessels. </p>
<h2>Know what you eat</h2>
<p>Whether sodium sensitivity affects the amount of salt we need for tasting or how the kidney handles sodium, these circumstances present special risks for certain individuals to develop high blood pressure. </p>
<p>Understanding the genetics behind these individual risks, and being able to inform individuals of their sodium sensitivity, are important steps in fighting the rise of hypertension in Canada.</p>
<p>Of course, while genetics are an important piece of the puzzle, there are non-genetic factors which also predispose individuals to high blood pressure or hypertension. </p>
<p>Regardless of sodium sensitivity, it’s important for Canadians to know that eating a poor, calorie-dense diet that includes processed and refined foods is an independent risk factor for hypertension. </p>
<p>Dietary sodium reduction remains the most promising preventative approach to avoiding the silent killer — even for individuals without sodium sensitivity. </p>
<p>If asked today whether you consume too much salt, would you know the answer? </p>
<p>Knowledge is power. Knowing what you eat offers the power to take control of your health.</p><img src="https://counter.theconversation.com/content/92663/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elie Chamoun receives funding from the Ontario Ministry of Agriculture, Food and Rural Affairs. </span></em></p>Most men, women and children in Canada exceed the tolerable upper limits of salt for their bodies. Consumers need to understand how much salt is too much – to avoid hypertension and heart disease.Elie Chamoun, PhD Candidate in Human Health and Nutritional Sciences, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/879752017-11-27T20:21:31Z2017-11-27T20:21:31ZFront-of-pack nutrition labels: why are certain agro-industrial firms resisting?<figure><img src="https://images.theconversation.com/files/195894/original/file-20171122-6013-1nv3q9j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In a supermarket candy and cookie aisle. October 31, France adopted the NutriScore, a labelling system designed to inform consumers about the nutritional value of food choices.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/fr/image-photo/wallonia-belgium-october-17-consumers-shopping-265259207">Defotoberg/Shutterstock</a></span></figcaption></figure><p>After nearly four years of effort, France recently adopted a food-labelling system that will allow consumers to see and compare at a glance the nutritional value of packaged food products. The government approved the “NutriScore” label, and it was signed into law in October. But some of the biggest global agro-industrial conglomerates are refusing to adopt it.</p>
<p>According to the <a href="https://www.quechoisir.org/">UFC Que Choisir</a> consumer-advocate organisation, the <a href="http://www.alliance7.com/">Alliance 7</a> trade group, which includes major manufacturers of breakfast cereals, candies and cookies, is encouraging its members to instead select another type of nutritional label. The trade group’s position is aligned with that of six food conglomerates – Mars, Mondelez, Nestlé, Coca-Cola, Unilever et PepsiCo (known as the “Big 6”) – who announced in March that they intended to develop an alternative system for the European Union. Some are also members of the Alliance 7, and the trade group’s “manifesto” states that it wants to “help consumers making informed food choices”. But some elements indicate that this strategy may have other goals.</p>
<p>Specifically, we wanted to know the classification of products from the “Big 6”, based on the official NutriScore. The results show that the majority are classified as being of low nutritional value – and suggest that the big corporations’ efforts to install an alternative label may be aimed more at confusing consumers than helping them.</p>
<h2>A label adopted after a long political process</h2>
<p>It’s worthwhile looking back on the political process that led up to the adoption of NutriScore system, developed in our research team in Paris 13 University. Based on a report delivered in 2014, the previous French minister of health, Marisol Touraine, chose the principle of a voluntary front-of-pack nutrition label. The proposal, based on EU regulations, was approved in December 2015 and the decree published in July 2016 with, at that point, no specific choice for the label’s graphical format.</p>
<p>The announcement of the selection of the NutriScore in March 2017 was based on a series of scientific studies, in particular the results of a large-scale trial conducted in 60 supermarkets at the request of manufacturers and retailers. It compared several label formats, and the one selected, the NutriScore, was confirmed by France’s current health minister, Agnès Buzyn, and co-signed by the ministers of Agriculture and the Economy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=156&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=156&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=156&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195895/original/file-20171122-6039-4xzhmy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">NutriScore, the official French front-of-pack label.</span>
</figcaption>
</figure>
<p>The NutriScore has five colours with the goal of informing consumers on foods’ nutritional qualities and thus allowing them to compare between food. The selection of this label was based on numerous studies published in international peer-reviewed journals. This approach that led the <a href="http://www.euro.who.int/en/countries/france/news/news/2017/03/france-becomes-one-of-the-first-countries-in-region-to-recommend-colour-coded-front-of-pack-nutrition-labelling-system">EU office of the World Health Organisation to commend</a> “France’s robust use of evidence to inform this decision”.</p>
<h2>An evidence-based label</h2>
<p>Studies conducted during the consultation process as well as independent research from teams at Inserm, INRA and other universities in France all have shown the superiority of NutriScore compared to other formats. Research looked at consumer perception, objective understanding and the labels’ impact on the nutritional quality of purchases in a range of experimental and real-life designs. The results of these studies are consistent, and show a greater efficiency of the NutriScore, both for the general population and for disadvantaged subgroups of the population or subjects suffering from chronic conditions like diabetes.</p>
<p>Despite the evidence, and in disregard of the positions of consumer associations who are asking for the NutriScore to be implemented, several agro-industrial lobbying groups have opposed the label. They resort to a simple strategy, shown to be successful in other sectors, such as tobacco: Unable to stop a political decision, they conjure up an alternative system – one potentially less damaging to their economic interests – by justifying its supposed advantages for the consumer.</p>
<p>The Big 6 have thus advocated a modified version of the “multiple traffic light system” <a href="http://www.foodlabel.org.uk/label/front-of-pack-labelling.aspx">currently used in the United Kingdom</a>, to be called “Nutri-Couleurs” in France.</p>
<h2>Ten pieces of data to help choose between a yogurt and a fruit purée</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=156&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=156&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=156&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195896/original/file-20171122-6039-1akzzu4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modified British</span>
</figcaption>
</figure>
<p>Various studies compared this label with the NutriScore and it was shown to be less efficient. Indeed, the NutriScore provides only one indicator of colour for the overall nutritional quality of the food: the foods having the highest nutritional quality are labelled in green. The alternative label provides information for each nutrient – a food could be labelled in green for sugars, but other colours for salt or fats. This type of label can be more difficult to understand for consumers. To choose between two products – for example, a yogurt and a fruit purée – the consumer needs to quickly compare ten different pieces of information, instead of just two with the NutriScore.</p>
<p>Moreover, the alternative label requires consumers to prioritize the information it contains. Between a product high in salt and low in lipids, and another that’s high in lipids and low in salt, which to select? This system therefore tends to confuse consumers compared to a more synthetic system.</p>
<p>To understand better the manufacturers’ objectives in proposing an alternative label, let’s immerse ourselves in the world they would have us experience. In its “manifesto Nutri-Couleurs”, published in October, the Alliance 7 trade group proposes, as do the Big 6, a modified version of the British “traffic light” system. Instead of deriving the colours from the content in nutrients for 100g, as in the original version, the thresholds would be based on a portion – in other words, the quantity usually consumed by an individual, which is extremely variable from one person to the next. Because manufacturers set the portion sizes of their products, they could manipulate them to give a better classification for their products than they would have had otherwise. The thresholds for the various colours have not yet been disclosed, and appear to be still under discussion.</p>
<h2>How the Twix bar could go from red to amber</h2>
<p>The case of the Twix chocolate bar, revealed by the UFC Que Choisir is particularly relevant:</p>
<blockquote>
<p>“The labels for Bounty and Twix chocolate bars (produced by Mars Incorporated) indicate portions corresponding to a single bar of the confectionery, which is sold with two bars in an individual packet. [This change is enough] to drastically lower the level of sugar and fats in the portion”.</p>
</blockquote>
<p>Using the NutriScore, the Twix bar is classified as red (E), the lowest nutritional quality:</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=156&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=156&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=156&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195898/original/file-20171122-6035-ksy73v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nutriscore for a Twix candy bar.</span>
</figcaption>
</figure>
<p>In the standard British system, all indicators are set to red, except for salt, which is set at amber:</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=156&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=156&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=156&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195899/original/file-20171122-6027-ey82z5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">British ‘traffic light’ label for a Twix bar.</span>
</figcaption>
</figure>
<p>With the modified label proposed by the “Big 6” and Alliance 7 group (of which Mars is a member), ratings are set based on the recommended portion – chosen by the manufacturer. Thresholds between colours not having been made public yet, the hypothesis is that that for red would be set at 20% of the reference intakes. Under this assuming, all indicators would change to… amber. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=156&fit=crop&dpr=1 600w, https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=156&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=156&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=196&fit=crop&dpr=1 754w, https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=196&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/195901/original/file-20171122-6061-11r3j5n.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=196&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Modified</span>
</figcaption>
</figure>
<p>Even with lower thresholds for red (15%, for example), most indicators would still be amber. And yet the product itself has not changed in the least.</p>
<h2>Fleury-Michon, Danone and McCain support the NutriScore system</h2>
<p>The EU commission confirmed the France’s selection of the NutriScore, justifying its support by the importance of public health. Given the consistency between the French and the EU positions, it’s worth asking why the members of the Alliance 7 trade group still refuse to use the NutriScore. Moreover, some retailers, including Intermarché, Auchan and Leclerc, have pledged to use the NutriScore on their products. Other agroindustry corporations, including Fleury-Michon, Danone and McCain, have also adopted the label.</p>
<p>To attempt to answer this question, we looked at the NutriScore classifications of the products from the Big 6 corporations. Thanks to the <a href="https://fr.openfoodfacts.org/">Open Food Facts</a> participative database, it’s possible to know the nutritional composition of most food products, and therefore the NutriScore classification even for those that do not provide this information.</p>
<p>The results indicate that corporations supporting the alternative label are those whose product portfolio contains foods high in fat, sugar or salt, all of which would be classified as lower nutritional quality in the NutriScore. Products featured include sweetened beverages, chocolate, confectionery, biscuits, breakfast cereals, ice creams or salty snacks. For example, in the Mars corporation, 100% of foods in the Open Food Facts database are classified as orange or red; for Mondelez, 86% of the products; and 55% for Nestlé, 54% for Coca-Cola, 52% for Unilever and 46% for PepsiCo.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196110/original/file-20171123-18006-1pq0eo8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of NutriScore grades for Mars products.</span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196107/original/file-20171123-17985-4jldjg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of NutriScore grades for Mondelez products.</span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196104/original/file-20171123-18021-8shsus.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of NutriScore grades for products from Nestlé.</span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196109/original/file-20171123-17982-8c13qd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of the NutriScore grades for Coca-Cola products.</span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196108/original/file-20171123-17988-4xz91i.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of NutriScore grades for Unilever products.</span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=307&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=307&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196106/original/file-20171123-17992-j4w0q4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=307&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Distribution of NutriScore grades for PepsiCo products.</span>
</figcaption>
</figure>
<p>The position of the corporations refusing to adopt official EU and French label thus appears to be primarily guided by their commercial interests and their marketing and strategic vision of the situation. The use of an alternative label would lead to more consumer confusion rather than less. From our point of view, consumers deserve transparence on a topic as essential to their health as nutrition. They should decide whether the position of these corporations is respectful of this imperative – and to react accordingly.</p><img src="https://counter.theconversation.com/content/87975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Serge Hercberg has received funding for his team's research from the French Public Health Department, the Ministry of Social Affairs and Health, ANR, Inca, ANSES, the University of Paris 13, the Fondation pour la Recherche Médicale and the Foundation Coeur et Artères.</span></em></p><p class="fine-print"><em><span>Chantal Julia has received funding for her research from Santé publique France, the Ministry of Social Affairs and Health and INCA.</span></em></p>France recently adopted NutriScore, a series of simple colour codes that will allow consumers to easily identify the healthiest foods. But some of the biggest food conglomerates are fighting back.Serge Hercberg, Professeur de nutrition, Université Sorbonne Paris NordChantal Julia, Médecin nutritionniste et enseignant chercheur, Université Sorbonne Paris NordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/543382016-03-17T19:21:06Z2016-03-17T19:21:06ZWhich are better, public or private hospitals?<figure><img src="https://images.theconversation.com/files/114598/original/image-20160310-26283-17ckw3l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The most common reason for choosing private hospitals is shorter waits for elective surgery.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-107400536/stock-photo-man-laying-in-a-hospital-bed-with-his-leg-raised-in-traction-with-flowers-and-cards-next-to-him.html?src=A_m07GiPC0QfE3cZrmJ02g-1-64">Richard Lyons/Shutterstock</a></span></figcaption></figure><p>Around <a href="http://www.apra.gov.au/Pages/phiac-redirect.aspx">half of Australians</a> have private health insurance. So if they need to go to hospital, they may have the option of going public or private. </p>
<p>Although some people try to research their options extensively, it’s a challenge to find any useful information about hospital options. Most rely on their own experiences, the experiences of friends and family, advice from their doctors, or what they see and hear in the media. </p>
<p>The <a href="http://www.apra.gov.au/Pages/phiac-redirect.aspx">biggest users</a> of private health insurance hospital benefits are 60- to 79-year-olds.
Women in their 20s and 30s also have a higher claim rate for maternity care. </p>
<p>But around <a href="https://theconversation.com/the-debate-were-yet-to-have-about-private-health-insurance-39249">a quarter of people</a> with private health insurance choose to use the public system.</p>
<p>Let’s look at how users choose whether to go public or private, and how the two systems compare.</p>
<h2>Users’ perceptions</h2>
<p>Participants in <a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">our research</a> of health-care choices were happy to use the public hospital system for emergency or acute health issues. They valued the high-quality medical care provided in those situations. As one participant said,</p>
<blockquote>
<p>In terms of medical care, I don’t see that there’s a difference because our best doctors are in our public health system.</p>
</blockquote>
<p>They were also happy there were no costs to use public hospitals. </p>
<p>But because public hospitals deal with emergencies and acute care, they found it a stressful environment, where the nursing staff were overworked. They also felt they had little choice about their care. </p>
<p>In contrast, when people talked about the benefits of the private hospital system, they talked about the hospitals as calm, not rushed, with sufficient staff, lovely rooms and a much “nicer” environment to be in. </p>
<p>Participants also talked about the importance of choosing their own doctor. Their choice of private hospital was most likely to be made on the recommendation of their doctor, usually a specialist. </p>
<h2>How they compare</h2>
<p>Australia has more public hospitals than private hospitals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=614&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=614&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=614&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=772&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=772&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133608/original/image-20160810-9203-1fqryzw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=772&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>But about two-thirds of elective surgery in Australia is provided in private hospitals. In 2009-2010, there were almost 1.9 million elective surgery procedures – 661,000 in public hospitals and 1.2 million in private hospitals. </p>
<p>In 2013-2014 in the <a href="http://www.aihw.gov.au/hospitals/">public system</a>, half of all patients were admitted for elective surgery within 36 days of being placed on the waiting list. Around 90% of all patients were admitted within 262 days. The list was longest in New South Wales, where patients waited an average of 49 days. </p>
<p>Waiting times are not available for the private sector, but they tend to be much shorter. </p>
<p>Your <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551486">hospital stay</a> is likely to be slightly shorter in a private hospital (5.1 days, on average) than a public hospital (5.7 days). This difference may partly be explained by higher numbers of patients requiring more complex care in the public system.</p>
<p>The chances of <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129551482">something going wrong</a> – for example, contracting an infection, falling, or receiving the wrong medication – is slightly higher for public hospitals (6.7%) than private hospitals (4.1%). Some of this difference may be because private hospital treatment is more likely to be planned (elective surgery), for which the risk of infection is lower.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115218/original/image-20160316-8465-1pc7ms0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Public hospitals are perceived as providing high-quality care, but in a stressful environment.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-132572702/stock-photo-empty-bed-in-busy-hospital-corridor-blurred-figures-with-medical-uniform-working.html?src=BnJkzIlWceFNuawRMX6MoA-1-13">VILevi/Shutterstock</a></span>
</figcaption>
</figure>
<p>While costs are difficult to compare, the <a href="http://www.pc.gov.au/inquiries/completed/hospitals/report/hospitals-report.pdf">Productivity Commission found</a> that general hospital costs (items such as ward nursing, hospital supplies and allied health services) are higher in public than private hospitals (A$2,552 versus A$1,953). </p>
<p>However, medical and diagnostics costs (which includes items such as x-rays and blood tests) are higher for private hospitals (A$798) than public hospitals (A$542). Prostheses costs were also higher: around A$542 in private hospitals compared with A$131 in public hospitals. </p>
<p>Treatment in the public system does not incur out-of-pocket expenses, whereas the choice to use a private hospital usually comes at a cost. On top of insurance premiums and excess payments to the insurance company, the <a href="http://www.apra.gov.au/PHI/PHIAC-Archive/Documents/Qtr-Stats-Report-Mar15.pdf">average out-of-pocket cost</a> per hospital episode is A$293.32, or 20% of the cost of private care. </p>
<p>Patients may also be charged gap fees for surgeons, anaesthetists, pathology and medical devices. </p>
<h2>Maternity care</h2>
<p>The choice to give birth in a private hospital is one reason people of childbearing age take out private health insurance. Around <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/pacd-maternityservicesplan-toc%7Epacd-maternityservicesplan-chapter3">30% of all hospital births</a> occur in private hospitals.</p>
<p>Despite evidence of a greater likelihood of <a href="http://theconversation.com/birth-intervention-and-harm-more-likely-in-private-hospitals-26801">interventions such as caesareans</a> in private hospitals, women in our study did not perceive that there were any risks in birthing in the private system. Indeed, some did not view caesarean birth, or other interventions, as a risk. </p>
<p>While it’s unlikely anything will go wrong during a caesarean birth, all types of surgery carry a small risk of infections and other complications. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115217/original/image-20160316-25523-1m3pu3a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women want continuity of care.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-216720409/stock-photo-woman-right-before-giving-birth-in-hospital.html?src=pp-same_artist-264090722-Kx3aKW2t9gN6ZvxTQpSGSg-5&ws=1">mathom/Shutterstock</a></span>
</figcaption>
</figure>
<p>Although many public hospitals provide continuity of care from a midwife during pregnancy, there is a general perception that in the public system you will see a different provider every time; many women don’t want this for their pregnancy experience. They also value the amenities in private hospitals, such as having a private room. </p>
<h2>Consumers need better information</h2>
<p>When deciding whether to use the private system, being aware of the costs and having appropriate cover <a href="http://theconversation.com/explainer-why-do-australians-have-private-health-insurance-38788">is key</a>. People may be prepared to pay for private care if they think they will get a higher quality of care and not have to wait. But this may not always be the case.</p>
<p>People are often vulnerable and anxious when they need to use hospitals. This is one reason the Commonwealth and state governments need to improve the information available to consumers about the differences in clinical care, costs, waiting periods and facilities between the public and private systems.</p>
<hr>
<p><em><strong>This article is part of our series <a href="https://theconversation.com/au/topics/hospitals-in-australia">Hospitals in Australia</a>. Click on the links below to read the other instalments:</strong></em></p>
<ul>
<li><p><strong><a href="http://theconversation.com/the-problems-with-australias-hospitals-and-how-can-they-be-fixed-54248">The problems with Australia’s hospitals – and how can they be fixed</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/infographic-a-snapshot-of-australias-hospitals-56139">Infographic: a snapshot of Australia’s hospitals</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/from-triage-to-discharge-a-users-guide-to-navigating-hospitals-54658">From triage to discharge: a user’s guide to navigating hospitals</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/how-much-seeing-private-specialists-often-costs-more-than-you-bargained-for-53445">How much?! Seeing private specialists often costs more than you bargained for</a></strong></p></li>
<li><p><strong><a href="http://theconversation.com/why-do-we-wait-so-long-in-hospital-emergency-departments-and-for-elective-surgery-54384">Why do we wait so long in hospital emergency departments and for elective surgery?</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/heres-how-to-boost-hospital-funds-and-end-the-blame-game-54247">Here’s how to boost hospital funds and end the blame game</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/do-you-really-need-to-go-to-hospital-time-to-recentre-the-health-system-54406">Do you really need to go to hospital? Time to recentre the health system</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/no-one-should-get-dud-hospital-care-its-time-to-lift-our-game-on-quality-and-safety-54561">No-one should get dud hospital care – it’s time to lift our game on quality and safety</a></strong></p></li>
<li><p><strong><a href="https://theconversation.com/hospitals-dont-need-increased-funding-they-need-to-make-better-use-of-what-theyve-got-54815">Hospitals don’t need increased funding, they need to make better use of what they’ve got</a></strong></p></li>
</ul><img src="https://counter.theconversation.com/content/54338/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Willis received funding from The Australian Research Council (ARC) for a project called 'Navigating the Health Care Maze - the differential capacity to choose (2013-2015).</span></em></p><p class="fine-print"><em><span>Sophie Lewis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around a quarter of people with private health insurance still choose to use the public system. Why?Karen Willis, Associate Dean (Learning and Teaching), Faculty of Health Sciences, Australian Catholic UniversitySophie Lewis, Senior Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/540412016-03-07T04:46:23Z2016-03-07T04:46:23ZHealth Check: what to do if you burn yourself<figure><img src="https://images.theconversation.com/files/113967/original/image-20160306-17726-182hl3r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Run the burn under cool water for 20 to 25 minutes.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mlazarevski/8108416027/">Marjan Lazarevski/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Burns are one of the most common injuries, affecting as many as <a href="http://www.fionawoodfoundation.com/our-challenge/current-statistics/">200,000 Australians</a> each year. Burns occur when skin cells are damaged by exposure to a flame (flame burns), a hot liquid (scald), a hot object (contact burns), ultraviolet or infrared radiation (sunburn), electricity, or chemicals. </p>
<p>Children are <a href="http://www.who.int/mediacentre/factsheets/fs365/en/">particularly vulnerable</a>, not only because of their natural curiosity, but also because their skin is thinner, which can result in more serious burns at lower temperatures. </p>
<p>Burns are classified based on size, usually expressed as a percentage of total body surface area, as well as severity, which is determined by the number of skin layers affected:</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113970/original/image-20160307-23874-yh2tlg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">First-degree burns cause minor blisters.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/uberculture/2017076330/">Jeremy Noble/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<ul>
<li><p>first-degree or superficial burns usually cause localised redness and swelling and only minor blisters</p></li>
<li><p>second-degree or partial-thickness burns typically appear moist red, with large intact or broken blisters</p></li>
<li><p>third-degree or full-thickness burns usually have a dry, charred or whitish appearance.</p></li>
</ul>
<p>For all burns, the first consideration should be to remove the victim, rescuer and bystanders from any dangers, including flames, hot liquids or live electricity. </p>
<p>Stop the burning process as quickly as possible – this includes extinguishing flames and removing hot or soaked clothing if they’re not stuck firmly to the skin. </p>
<p>Cooling the burn with cool running water for 20 to 25 minutes efficiently removes heat, prevents further progression of the burn and relieves pain. While cooling should be initiated as soon as possible, it remains effective for up to three hours after the <a href="http://anzba.org.au/?option=com_content&view=article&id=54&Itemid=60">initial injury</a>. </p>
<p>A <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147259">recent study found</a> water cooling reduced swelling and improved wound healing for minor burns commonly encountered at home or work. For severe burns, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147259">water cooling reduced the need</a> to be admitted to intensive care or undergo wound repair surgery.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113969/original/image-20160306-17744-155eiv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ice can cause more harm than good.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/calliope/2591108804/">liz west/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>But when it comes to cooling a burn, more is not more. Using ice or ice water is actually detrimental because extreme cold causes constriction of blood vessels and thus worsens the injury. </p>
<p>Similarly, excessive cooling can cause a dangerous drop in body temperature. </p>
<p>Because of this, cooling should be limited to 20 to 25 minutes and only the affected area should be cooled. Take care that body temperature doesnt’t drop, particularly in children who have less body mass and thus lose heat more easily.</p>
<p>Once cooling has been started, remove any jewellery, as burns often lead to localised swelling. Tight-fitting rings, watches or bracelets can restrict blood flow to the burnt limb or fingers, which can cause further tissue damage.</p>
<p>After the burn has been cooled, cover the wound with a sterile, non-adherent dressing or cling film (although this should never be used on the face to avoid accidental suffocation). All dressings should be applied loosely to avoid restricting blood flow.</p>
<p>Don’t touch the injured area, burst blisters, or apply lotions, ointments or creams to burns unless instructed to do so by a health care professional. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/113972/original/image-20160307-17726-7qzbsp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Butter won’t help.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/stone-soup/7534322070/">jules/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>There is little evidence to support the use of home remedies like applying butter, oil, tea, toothpaste, flour, onion, eucalyptus, lavender or tea tree oil. Many of these treatments are rooted in folklore and their use is not supported by evidence. Some of these treatments can be detrimental as they impair prompt assessment by a medical practitioner. </p>
<p><a href="http://stjohn.org.au/assets/uploads/fact%20sheets/english/FS_burns.pdf">Seek medical advice</a> for: chemical or electrical burns, burns in the elderly or children, deep burns, burns that are larger than a 20 cent coin, or burns that affect the airways, face, hands, major joints, feet and genitals.</p>
<p>Pain from superficial burns is best managed with simple analgesics such as paracetamol. Keep in mind that severe burns may not be painful, as the nerve endings in the skin may be completely destroyed. </p>
<p>As with all injuries, prevention is the best cure. Make your home and workplace safer by identifying and eliminating burns hazards, and learn first aid.</p><img src="https://counter.theconversation.com/content/54041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Irina Vetter has received funding from the University of Queensland for research into burns injury-induced pain.</span></em></p>Burns are one of the most common injuries, affecting as many as 200,000 Australians each year.Irina Vetter, Australian Research Council Future Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/503842015-11-09T19:20:18Z2015-11-09T19:20:18ZAged and confused: why the private health insurance industry is ripe for reform<figure><img src="https://images.theconversation.com/files/101228/original/image-20151109-7496-13ku9j6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Consumers face significant out-of-pocket costs when using their insurance.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-107400536/stock-photo-man-laying-in-a-hospital-bed-with-his-leg-raised-in-traction-with-flowers-and-cards-next-to-him.html?src=kOSJw7Mi5ouKCepY_4nd8A-1-9">Richard Lyons/Shutterstock</a></span></figcaption></figure><p>Among a number of reviews announced by Health Minister Sussan Ley is a comprehensive review of private health insurance. This will include consultative round tables for industry, consumer groups and academics, as well as a survey designed to gather consumer opinion about health insurance policy.</p>
<p>The <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/PHIconsultations2015-16">survey</a>, which opened yesterday, has generated extensive commentary over whether private health insurers should be able to vary their premiums to charge more based on member characteristics such as age, gender and smoking status.</p>
<p>But there are other questions that ask about the consumer experience of health insurance, which may be the most productive area for reform. </p>
<h2>Pressure for change</h2>
<p>Private health insurance in Australia is a peculiar hybrid. It has a <a href="https://theconversation.com/medibank-privates-treatment-of-calvary-is-truly-a-via-dolorosa-for-consumers-46322">love-hate relationship with private hospitals</a> and, despite the name “private”, is heavily regulated and subsidised by government.</p>
<p>The government subsidy is one reason for the renewed focus on the industry. The Commonwealth subsidy for private health insurance is <a href="http://www.budget.gov.au/2015-16/content/bp1/download/Budget_Paper_No_1.pdf">expected to grow</a> 7% in real terms over the period 2015-16 to 2018-19, up to A$7.3 billion in 2018-19. </p>
<p>This is much faster than Commonwealth health spending growth overall (3.2%), and faster than growth in Commonwealth support for public hospitals (6.7%).</p>
<p>Pressure for change is also coming from consumers. A <a href="http://www.accc.gov.au/media-release/accc-report-on-the-private-health-insurance-industry">recent report</a> from the Australian Competition and Consumer Commission shows a significant increase in complaints about private health insurance from consumers facing significant out-of-pocket costs when using their insurance, despite having paid premiums for decades. </p>
<p>The report concluded that:</p>
<blockquote>
<p>some consumers find it difficult to understand the extent of their cover, the costs they are likely to incur if they use a health service and determining who to seek information from (insurer or health provider).</p>
</blockquote>
<h2>How does the system work?</h2>
<p>There are two broad types of private health insurance products: hospital and general (ancillary) insurance.</p>
<p>About 47% of the population has hospital insurance and about 55% has general insurance. The market dynamics for the two types of insurance are quite different.</p>
<p>Hospital insurance is a true insurance product. People take out insurance just in case they might need admission to a private hospital some time in the future. They mostly have no control over whether (or when) they’ll need it. </p>
<p>General insurance is quite different. It covers much more discretionary services including allied health services, dental services (including preventive dental services) and natural therapies (including hypnotherapy). People with this type of insurance may want to make sure they get their value for money by using services up to their limits.</p>
<p>In addition to subsidies, there are penalties on middle- to high-income earners who don’t have private hospital cover. Single people with an income over A$90,000 a year (families over A$180,000) pay a 1% levy on their taxable income if they don’t have <a href="http://www.privatehealth.gov.au/HealthInsurance/IncentivesSurcharges/insurancerebate.htm">hospital insurance</a>; higher-income earners pay a higher levy. </p>
<p>For higher-income earners, private hospital insurance is effectively free, since the cost of hospital insurance is lower than the tax they would pay if they did not have it. For people in this situation, private health insurance purchase becomes a tax-minimisation strategy.</p>
<p>Obviously, the cost to the consumer of private hospital cover can be reduced by taking out a product that provides lesser coverage, either by “reduced cover”, requiring the consumer to pay money up front if they use the policy (a deductible), or by specifying exclusions from the policy. </p>
<p>The vast bulk of policies now have deductibles or exclusions or both – only about one in eight policies provides full coverage without deductibles and exclusions. Ten years ago about 40% of policies had no deductibles or exclusions.</p>
<p>The greater the proportion of people facing deductibles and exclusions, the greater the risk that people will not know what their coverage actually is, and be dissatisfied with their level of insurance when they do. </p>
<p>Private health insurance policy hasn’t kept pace with this change in composition of the insured. The high level of complaints suggests that consumer protection provisions need to be strengthened.</p>
<h2>Everything is on the table</h2>
<p>Almost 50 years ago the last major review of private health insurance <a href="http://trove.nla.gov.au/work/12429969?selectedversion=NBD43163057">found that</a> “private health insurance is unnecessarily complex and beyond the comprehension of many”. It appears we are back in that same position. </p>
<p>The Australian Competition and Consumer Commission report, together with a similar overview of health insurance complaints put together by the <a href="http://www.phio.org.au/about-phio/about-phio.aspx">Private Health Insurance Ombudsman</a>, point to the key changes necessary. </p>
<p>First, product information needs to be simplified and standardised. Consumers rightly complain about the unexpected; limitations on coverage should be explicit and easy to find. Enforceable limitations should no longer be able to be buried deep in the fine print. </p>
<p>Second, the Private Health Insurance Ombudsman should be funded to undertake more regular advertising of its <a href="http://www.privatehealth.gov.au/">fund comparison website</a> and to include more information on the website about complaints. </p>
<p>Third, funds already provide their contributors an annual tax statement. Funds should be required to provide contributors a statement about the fund’s performance prepared by the Private Health Insurance Ombudsman at the same time. This would help consumers decide whether they should switch funds. Over time, this statement could become more sophisticated, warning consumers about particular exclusion clauses that are causing grief. </p>
<p>Fourth, the Australian Competition and Consumer Commission should be more aggressive about pursuing false and misleading claims by private health insurers and, if necessary, consumer protection legislation should be strengthened to capture the dodgy practices outlined in the commission’s reports. </p>
<p>Finally, we should not have to wait 50 years for another serious review of consumers’ health insurance experience. Some form of review of the effectiveness of consumer protection provisions should be undertaken at least every five years.</p>
<p>The review must aim to strengthen consumer protection so Australians can make informed choices about the products they buy.</p>
<hr>
<p><em>Stephen will be on hand for an Author Q&A between 10 and 11am AEDT on Wednesday, October 11, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/50384/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett has private health insurance as a tax minimisation strategy.</span></em></p>The private health insurance is complicated and difficult to navigate. Here’s what we need to do to better protect consumers.Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/387882015-03-29T19:05:51Z2015-03-29T19:05:51ZExplainer: why do Australians have private health insurance?<figure><img src="https://images.theconversation.com/files/76196/original/image-20150327-8699-m5550s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dental care is the most-used private health insurance ancillary service. </span> <span class="attribution"><a class="source" href="http://one.aap.com.au/#/search/dentist?q=%7B%22pageSize%22:25,%22pageNumber%22:2%7D">Peter Kyikos/AAP</a></span></figcaption></figure><p>All Australian residents have access to Medicare, so why do <a href="http://phiac.gov.au/">half the population</a> also decide to take out private health insurance? And what do they get out of it?</p>
<p>The <a href="http://phiac.gov.au/wp-content/uploads/2014/11/qtrstats-Sep14.pdf">biggest users</a> of private health insurance hospital benefits are 60- to 79-year-olds. Women in their 20s and 30s also have a higher claim rate for maternity care. </p>
<p>Payments for extras is <a href="http://phiac.gov.au/wp-content/uploads/2014/11/qtrstats-Sep14.pdf">spread</a> across all age groups, with the biggest component going to dental care, followed by optical, physiotherapy and chiropractic.</p>
<h2>Choice, cost and public service</h2>
<p><a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">Our research</a> shows that some people purchase private health insurance because they want more control over their health care, choice about the services they use and choice of doctor. </p>
<p>They perceive that private health insurance gives them benefits including shorter wait times, choice of the timing of appointments, better quality of care and security or “peace of mind”.</p>
<p>As one of our interviewees responded: </p>
<blockquote>
<p>As a private patient I can … choose my treating specialist and I can say I’m available on these days, how does that work for you, rather than sitting on the wait list. I mean, it costs out of pocket, but I am lucky enough to be in a position that cost isn’t a huge barrier for me. </p>
</blockquote>
<p>Another reason Australians commonly take out private health insurance is to avoid <a href="https://theconversation.com/private-health-insurance-means-test-passes-what-now-5356">financial penalties</a>. </p>
<p>Australia’s tax system encourages high-income earners to take out private health insurance as well as paying the 2% levy to help fund <a href="https://www.ato.gov.au/Individuals/Medicare-levy/">Medicare</a> and the National Disability Insurance Scheme. </p>
<p>If they do not take out private health insurance, they pay a tax penalty called the <a href="https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/When-do-you-have-to-pay-the-surcharge-/">Medicare Levy Surcharge</a>:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=252&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=252&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=252&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=317&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=317&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76065/original/image-20150326-12309-1o84wjq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=317&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Australian Taxation Office</span></span>
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<p>Some under-31-year-olds take out private health insurance to avoid paying a <a href="http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/lifetimehealthcover.htm">lifetime health cover loading</a> which takes effect by July 1 following their 31st birthday. If they take out private health insurance after turning 31*, they pay an extra 2% for every year delay. </p>
<p>People also take out private health insurance to access subsidies for allied health services such as visits to the dentists and the cost of glasses, which are not covered under Medicare. </p>
<p>Finally, our research shows some Australians purchase private health insurance because they perceive that this will reduce the burden on the public system: </p>
<blockquote>
<p>We used our health fund, because we wanted to help the hospital out. </p>
</blockquote>
<h2>Hidden costs and surprises</h2>
<p>Having private health insurance does not necessarily give people greater choice or access to health care. Access may be limited by what is available in the local area, or the ability to pay additional out-of-pocket costs. </p>
<p><a href="http://sydney.edu.au/health-sciences/research/healthcare-choice/index.shtml">Our research</a> indicates that some people don’t know the type of policy they have, and what it covers. They may be paying too much or are not covered for procedures that they do need. </p>
<p>Consumers are also hit hard by the “unknown” or “hidden” costs of private services that are not covered in full by insurance. As one interviewee told us: </p>
<blockquote>
<p>I probably didn’t research it properly to know what I’d be covered for, so I was surprised that I wasn’t covered, but I shouldn’t have been … Yeah I paid around almost A$5,000 for the surgeon and surgeon’s assistant and [am] only going to get the Medicare cover for that. Then also an anaesthetist … my private health insurance won’t cover that either.</p>
</blockquote>
<p>Gap payments may include costs for the hospital stay, doctor’s fees, procedures, equipment and prosthesis. But there is very little information for consumers about the gap they’re expected to pay. The onus is on the patient, before they go to hospital, to ask their surgeon to estimate what their charges will be, and ask their health fund how much is covered with their policy. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76199/original/image-20150327-4777-w4kdm0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Respondents often had positive experiences in the public hospital system.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/twentysixcats/3850965022/in/photolist-6SicJE-5v8Com-632kAe-3ouq3D-eiZYGZ-8DW71F-cbHzdQ-636zxh-anoMTQ-5S4S2B-d4pQnS-kSAHkt-crVL5C-4BroPs-hfwSgV-9u3yBs-5Yt79V-6u9QTC-8hciMG-dtzEsE-b1d7Wx-aiCrK9-a5tAAd-6UKzJD-dnbWk9-dUcEav-crVKBJ-7YoE2Z-frdt1L-5NTvFA-89miKd-7BypF1-3vPVvt-89miSu-bHc2vT-hgbv47-hgcLQK-hgcVg2-djfMyn-6aduLa-4GeBT1-8NQQDw-cR1yJE-hgcPvz-hgcJqK-9TxqGg-pgNWPU-8mh8fz-dnbShn-tyrgy">twentysixcats/Flickr</a></span>
</figcaption>
</figure>
<p>Out-of-pocket expenses for hospital benefits <a href="http://phiac.gov.au/wp-content/uploads/2014/11/qtrstats-Sep14.pdf">average</a> A$285.27 per episode, and the average out of pocket cost per episode covered for ancillary benefits A$46.47 (in the quarter to September 2014).</p>
<p>Out-of-pocket costs will vary greatly depending on what hospital they choose, the specialist they see, and their policy and excess, as funds will have different arrangements with different hospitals. Doctors are free to set their own fees and decide on a case-by-case basis whether to use an insurer’s gap cover arrangement. </p>
<p>This means some consumers feel that they pay more than once for their health care needs. As one respondent said:</p>
<blockquote>
<p>I think sometimes it’s unfair. Because we pay a Medicare levy, we pay private health insurance, and we pay a gap, so we pay three times.</p>
</blockquote>
<h2>Public or private?</h2>
<p>Some people with private health insurance choose not use it, and instead access public services. </p>
<p>Many of our participants had positive experiences in the public system, particularly in emergency situations, for low-risk procedures or when there were no waiting periods. </p>
<p>Some thought the quality of care in both public and private hospitals was the same, or that choice of doctor or a private room was not certain. </p>
<p>Others, who accessed a public hospital as a private patient, were surprised that they did not receive a better level of care: </p>
<blockquote>
<p>We were still in a mixed room, shared room. We had no choice about beds, we had no choice or any of those options. The level of care was the same.</p>
</blockquote>
<p>Where people are able to choose – and are able to pay the out of pocket expenses – factors such as waiting periods influence their decision to have these procedures done privately.</p>
<p>People waiting for total knee replacements, for example, are likely to experience pain and restricted mobility, which can <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129544691">reduce their quality of life</a>. But the procedure has one of the longest public hospital wait times: a median wait time of 196 days, with 12% of patients waiting over one year. </p>
<p>This drove a <a href="http://www.hica.com.au/health-insurance-news/the-growing-cost-of-hip-and-knee-replacements">41% increase</a> in private knee replacement surgeries from 2011-12 to 2012-13. </p>
<h2>Is it worth it?</h2>
<p>Government rebates for private health insurance are now <a href="http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/insurancerebate.htm">means tested</a>. So, rather than everyone with private health insurance receiving the 30% rebate, the rebate is tiered:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/76090/original/image-20150326-30367-2bmtlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">health.gov.au</span></span>
</figcaption>
</figure>
<p>The mix of levies, surcharges and rebates can make it difficult for consumers to judge the true cost and value of their private health insurance policy or whether they may be better to rely on the public system to meet their health needs.</p>
<p><em>* This article has been updated to reflect that people pay the lifetime health cover loading when taking private health insurance out after their 31st birthday.</em> </p>
<hr>
<p><em><strong>Click on the links below to read the other instalments of <a href="https://theconversation.com/au/topics/private-health-insurance-in-australia">Private Health Insurance in Australia</a>:</strong></em></p>
<p><a href="http://theconversation.com/can-private-health-insurers-justify-a-6-2-premium-increase-38390">Can private health insurers justify a 6.2% premium increase?</a> </p>
<p><a href="https://theconversation.com/infographic-a-snapshot-of-private-health-insurance-in-australia-39237">INFOGRAPHIC: A snapshot of private health insurance in Australia</a> </p>
<p><a href="http://theconversation.com/private-health-insurance-carrot-and-stick-reforms-have-failed-heres-why-38501">Private health insurance ‘carrot and stick’ reforms have failed – here’s why</a> </p>
<p><a href="https://theconversation.com/if-the-government-wants-price-signals-it-should-stop-supporting-health-insurance-38389">If the government wants price signals, it should stop supporting health insurance</a></p>
<p><a href="https://theconversation.com/allow-aussies-to-opt-out-of-medicare-and-rely-on-private-health-insurance-38647">Allow Aussies to opt out of Medicare and rely on private health insurance</a> </p>
<p><a href="https://theconversation.com/the-debate-were-yet-to-have-about-private-health-insurance-39249">The debate we’re yet to have about private health insurance</a></p><img src="https://counter.theconversation.com/content/38788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Willis receives funding from The Australian Research Council for a project on healthcare choice</span></em></p><p class="fine-print"><em><span>Marika Franklin and Sophie Lewis do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>All Australian residents have access to Medicare, so why do half the population also decide to take out private health insurance?Sophie Lewis, Senior Research Fellow, Centre for Social Research in Health, UNSW SydneyKaren Willis, Professor, Allied Health Research, Melbourne Health, La Trobe UniversityMarika Franklin, PhD Candidate, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.