Video Tutorial: Casual Make Up

Olla ladies, just a quick one to share my video make up tutorial :)



Hope this one will help you to have an idea on how usually I do my casual make up. This time round, all the 24H make up products are sponsored by Tokyo Luxey.







Let me know what do you think if the video and what will be the next video you are looking forward to see ^^



'Till next time.

Happy 10th anniversary Kiehl's

Happy 10th anniversary to Kiehl's!

Wishing Kiehl's greater years to come and many more happiness to the awesome team behind it.



I dedicated this post to Kiehl's because I want to share with you that Kiehl's products are good. My favourite items so far are the deep pore cleansing mask and the Kiehl's ultra for the drier skin. This two are awesome for my skin. Apart from that, le Mr. is

Welcoming my new job as full time Mommy!

Akhirnya daku putuskan untuk nulis buat kalo nanti taon taon depan gw baca lagi, gw bisa bandingin apa yang gw give up in sekarang se worth it apa di ke depannya :)Sesuai judul, daku sudah berenti kerja..tepatnya sebulan lalu :)Well, dari awal taon sejak gw kelar maternity leave, gw uda work from home dibantuin sama mama gw or mama in law. Tapi this time round, gw totally dah berenti dari

Lovely range from Panier Des Sens

As someone who loves scented items, Panier Des Sens collections are perfect to pamper my busy day as stay home Mommy.






At first, I thought, being a full time mom means i have free time at home to do whatever I like and pretty much nothing much to do - maybe it's true for some lucky mommy. But for me, taking care of my 9 months old love alone, and without a help of maid can be pretty

The screening pelvic examination: not annual, not ever

The Dispute Over Annual Pelvic Exams, an editorial in the New York Times July 3, 2014, highlights an issue about which I have written before, including Primary Care Contributes More than Money...., June 2, 2013 and President Bush's stent: inappropriate screening and care for the rich, nothing for the poor, September 7, 2013. The Times has also had articles on the same subject, notably Questioning the pelvic exam, by Jane Brody, April 29, 2013. The impetus was a recent guideline recommendation from the American College of Physicians (ACP), the specialty society for internal medicine physicians, that recommended against doing this test on an annual basis.[1]

This examination is not to be confused  with the Pap smear screening test for cervical cancer (although it regularly is). The Pap smear involves obtaining cells for cytological examination from the cervix by means of a spatula and/or small brush. The Pap smear is not perfect, but it is probably the best of the cancer screening tests available to us; the US Preventive Services Task Force (USPSTF) recommends them in women 21-65 years of age every 3 years. The pelvic exam, the part where the doctor puts her/his hands inside a woman and feels around, is often done in conjunction with the collection of the Pap, thus the basis for the confusion among many women. It is not recommended by USPSTF at all, at any frequency[2], but the American College of Obstetricians and Gynecologists (ACOG) recommends it on an annual basis.

I have long been a teacher of family medicine, and for many years have told my students and residents that there was no indication for this examination, at any frequency, for screening. I do this despite the fact that I know they are taught to do so on their OB-Gyn clerkships and rotations, and not because I believe I am more experienced in providing women�s reproductive health care than are the OB-Gyns. I can, however, read the evidence. By definition screening occurs in asymptomatic people; should a woman present with symptoms referable to the pelvic region (for example, pain, bleeding or discharge) the examination may be indicated. However, in the absence of symptoms it is a screening test, and should not be done because there is nothing that it can screen for. Years ago, an argument for doing it was screening for ovarian cancer, but many studies have demonstrated that it is not effective for this purpose, because by the time an ovarian cancer can be felt by the examiner, it is very far gone. These are essentially the same reasons that USPSTFand ACP recommend against it.

And, yet, ACOG, as noted, continues to recommend it (�Annual pelvic examination of patients 21 years of age or older is recommended by the College.�). The Times editorial notes that

�the gynecologists group argues that the �clinical experiences� of gynecologists, while not �evidence-based,� demonstrate that annual pelvic exams are useful in detecting problems like incontinence and sexual dysfunction and in establishing a dialogue with patients about a wide range of health issues.

This defense ranges from the indefensible (that it is not evidence based) to the absurd (that it is the way to find problems like incontinence and sexual dysfunction). If a woman has incontinence or sexual dysfunction, she knows it and the way to discover it is not by a pelvic exam, but by asking her. Clearly, the same is true of �establishing a dialogue with patients about a wide range of health issues.� I strongly doubt that most women would feel that having the doctor put his/her hands inside her vagina is the best way to open such a dialogue!

Why, then, would ACOG continue to recommend it? Long ago, when I was in medical school and residency, almost all OB-Gyns were men, and lack of empathy could be a possibility, but this is far from the case now or in recent decades. There is also the fact that such an examination, as a procedure, is reimbursed at a much higher rate than simply talking to a patient. This is true also for family physicians and other primary care providers (such as general internists, which explains the ACP�s interest in the issue), but for OB-Gyns it is a much greater percentage of their practice and thus their income. It is hard to break with tradition, to change the way that you have always been taught, and it is probably harder when there is a concrete disincentive (loss of income) for changing.

But women, and all people, need to be able to trust that their doctors are recommending and doing procedures, particularly invasive and uncomfortable procedures like the pelvic examination, only when they are indicated by the evidence. They need to have confidence that those physicians are not motivated, consciously or not, by a conflict of interest (e.g., financial gain). One step is for physicians to honestly look at the evidence, and avoid prioritizing their anecdotal experience over that evidence.

More profoundly, however, our society, our health care system, needs to eliminate perverse incentives for doing �more� even when it is not indicated, still less when it is also unpleasant for the patient (like a pelvic exam), and least of all when it is also dangerous (as other procedures are). Physicians should be paid for maintaining and increasing the health of their patients, not for �doing things�. If talking to the patient about �a wide range of health issues�, including but not limited to incontinence and sexual dysfunction, is the right way to find out about these problems, and if it takes a long time, then this is what needs to be reimbursed, not a procedure.

We are currently a long way from this sort of reimbursement, for spending the time needed to provide the best health care for a person. It is good that ACP has added its voice to recommending against screening pelvic examinations, but it is unsurprising that doctors do what they are paid to do. We need system change.

---

[1]Qaseem A, et al, �Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians�, Annals of Internal Medicine 2014;161(1):67-72. doi:10.7326/M14-0701.

[2] http://www.uspreventiveservicestaskforce.org/uspstf12/ovarian/ovarcancerrs.htm 

My signature eyeliner look.

Latest eyeliner favourite by Starlash!



I am loving this because it's glide smoothly and stays throughout the day - No matter if you stays Indoor or outdoor. I actually don't see this quality coming from a new player - but Starlash that started with their lashes range never failed to impress me.



So, put this brand in your favourite checklist ladies, you won't regret it!







Just a

Biolee journey with me - Part 1

Hallo! Is there anyone suffering from Acne? If you do, i think it's important to know about Biolee, who knows this one is a life saving skincare for your acne :)










Before we start, let me share with you what is this Biolee Acnepris is all about. Acn�pris products are formulated for treating acne problems of women in their 20?s and 30?s. acn�pris is a quality natural cosmetic brand that

How to create powerful make up with simple items?

Hello ladies!





I am sharing up my little guidance especially for you who standing in front of make up counter and wondering what to buy to create a powerful make up. You can actually stock up many foundations, blushes, eye shadows and as much lipsticks as you like - but if you are not that kind of person, I hope i can share my basic tips on getting make up stuff.



Let's start this, shall

Virgin trip to Japan

Super late post! Tapi bakal tetep aye pajang :)



I LOVE JAPAN and definitely my virgin trip worth every cents of it!

Me and Mr. booked Japan Airlines and it cost us around SGD700/pax for a return flight.

Japan airlines service is awesome! To my surprise, it's better than Singapore Airlines.



We took night flight and were so excited to start our trip!





Upon landing in Haneda, I was

[Recipe] Ayam cabai hijau - Fried Chicken with green chilli

Hello All!

Sorry for the delay in posting my Mother In Law recipe of Crispy chicken with green chilli.

So this is typically Indonesian food that you will find in Padang Restaurant, and thanks to Mommy in law skill in Padangnese cooking - now we all can enjoy this simple, easy yet delicious restaurant food at home.



There are many other version available in the internet, but for me..nothing

Little sneak peak of my transformation with Mary Chia

Back to my update on Mary Chia treatment!



When I shared my Mary Chia journey with some people..one of my friend said that what I lose in Mary Chia is only water weight! and not the fat. Hmmff..how should I put this thing to Miss know everything?



I would say, yes It's true that you lose the water weight during the treatment, but what you don't know..is during the treatment - the machine and

Etude Magic Cushion and what I think of this product!

Hello ladies, sharing up the pretty stuff for Etude House.

We all definitely know when it comes to ETUDE brand, we are thinking about Korean look and Korean cosmetics. That is totally right! and talking about Korean, we definitely can't get enough of the glowing skin and " Oh so natural "complexion that is dewy and looking healthy, yes?



This time round, Etude launch 6-in-1 Precious Mineral

Flat tummy after baby?

Yes you can have it back!



I got my flat tummy back with the help of Mary Chia team :)

Weehee! Lucky me, and bless them for blessing me with this journey!



So, If you follow my weekly update through my blog or instagram..you are surely know that now I am already lighter than my pre pregnancy weight. - BIG grin -



One of the key factor that got me my flat tummy back is the Anti Cellulite

Treatments that don't cure the disease; we are spending money on the wrong things

In �Heralded treatments often fail to live up to their promise� (Kansas City Star, May 17, 2014), Alan Bavley, writing with Scott Canon, continues to demonstrate that he is one of the excellent health journalists � excellent journalists � in the US, along with Elisabeth Rosenthal of the New York Times. The common practice in the news media (and, thanks to a typo, �medica�) is to hype the new, exciting, dramatic, expensive, and hard to believe even though you want to. In politics, we often see the media acting as flaks for the government, the rich, and the powerful (sometimes, of course, these can be in conflict). Bavley and Rosenthal  and their ilk actually do investigative journalism, trying to the best of their ability to find out the truth rather than to reprint press releases.

The article begins with a review of a surgical procedure that was designed to control high blood pressure (hypertension) without drugs, by cutting some of the nerves to the kidneys. It made sense, it was seen as a big breakthrough (�The potential benefit was huge,� said a cardiologist). Unfortunately, when actually subjected to appropriate scientific study, it didn�t work. Or, rather, it worked just as well as placebo, a sham surgical procedure. The same cardiologist remarks ��This could be considered the biggest disappointment in cardiology of this century, but �the medical community went about it right.� 

Science worked. Unfortunately, the authors add,

�If only that were always the case. A combination of industry marketing, overly eager doctors, demanding patients and news media ready to cheer on anything that sounds like a breakthrough is popularizing many drugs, surgeries and other treatments long before they�re adequately tested. Far too often, they�re ultimately proved ineffective, no better than older, cheaper therapies, or even hazardous. Billions of dollars are wasted and tens of millions of patients are put at risk�

Yup. They go on to cite the Vioxx scandal, in which Merck concealed evidence of its biggest-selling drug causing an increase in heart disease. But that was taken off the market; many other unproven (or worse, proven to be ineffective) treatments are not. They talk about arthroscopic knee surgery, still often being done for conditions for which it has been shown to be no more effective than a sham procedure. They discuss surgical robots, costing upwards of $1.5 million, and proton-beam radiation treatments (those babies, the machines, really cost a lot!) for which the evidence of effectiveness compared to more standard and much cheaper treatment is mixed, at best. But hey, if you�re a hospital, and the competition has robots and proton-beam accelerators, who�s going to come to you if you don�t have one? Poor people? Heaven forfend!

And it is all about getting the advantage on the competition to make more money. A good argument can, and should, be made that competition in hospitals helps no one. That if there were an expensive item that there were an actual medical need for one of in the community, there should be one, not one at every hospital. But that would presume that the goal of the health system was to increase the health of the American people at the lowest effective cost. It isn�t. It�s to make money. If I can get your patients to come to me instead, it is seen as a victory (from a competitive business sense). It is really a loss for the health of our people and the pocketbooks of us all.

It is particularly depressing because that money is not buying us health. If you still harbored the belief that �we have the best health care system in the world�, it�s time to acknowledge that you are wrong (although we forgive you given the hype!). We should all know how expensive our health care system is, that we spend way more than any of the other developed countries (members of the Organization for Economic Cooperation and Development, OECD). The attached graph, from Steven Woolf, MD, PhD, who was a plenary speaker at the recent Society of Teachers of Family Medicine Annual Conference, shows a comparison of spending and life expectancy for the OECD countries. That�s the US way off to the right, spending more than anyone by far, but having a life expectancy close to the Czech Republic. Better than Mexico, Poland, Slovakia, Hungary and Turkey, but at enormously greater cost!

Woolf was the lead author of the Institute of Medicine�s (IOM) recent report �Shorter Lives, Poorer Health� , which presents depressing, but unfortunately accurate, data on our health status. We are among the �leaders� in death rates from communicable and non-communicable diseases and from injuries. Only for a few causes are our death rates better than the average. Our life expectancy at birth is worse than any of the 17 comparison countries for men, and second worst for women. Our probability of survival to age 50 is lower than any of 21 comparison countries. At any age until 75, we are never better than 15 out of 17 in terms of life expectancy. We do have better survival rates once we reach age 75, but there is no information on how much of that is keeping people alive despite poor quality of life.

Want more? In case you think it is only the minority populations (although that would be part of our population), non-Hispanic whites rank no higher than 16 of 17 at any age below 55. And the only portion of our population for whom mortality rates have risen is non-Hispanic whites with less than 12 years of education. From 2005-2009, the US had the highest infant mortality rate of the 17 countries and the 31st highest in the OECD. Non-Hispanic whites and mothers with 16+ years of education also have higher infant mortality rates than those in other countries. Among the 17 peer countries, mortality from transport accidents decreased by 42% in the OECD between 1995 and 2009, but by only 11% in the US. The same trends hold for child and adolescent health � and ill-health and mortality.

And then there are the areas where we really shine, particularly health issues related to guns.

• In 2007, 69% of US homicides (73% of homicides before age 50) involved firearms, compared with 26% in peer countries.
• A 2003 study found that the US homicide rate was 7 times higher (the rate of firearm homicides was 20 times higher) than in 22 OECD countries.
• Although US suicide rates were lower than in those countries, firearm suicide rates were 6 times higher.

We have the highest child poverty rates in the OECD, our preschool enrollment is below most countries, and the ratio of social services spending to medical spending is below almost all other OECD countries.

This is insanity. We are spending enormous amounts of money, but we are spending it so that our hospitals can compete with each other, so that we can deliver the most expensive and high-tech care whether it benefits people�s health or not, and we then do not have any money left to do the things that would really enhance health: expanding education, creating jobs, decreasing poverty, ensuring that people had homes and enough to eat.

Not to mention the guns.

[Review] KUU Konjac Sponge

Olla nona nona..inget ga daku pernah share soal Baby Ethan dikirimin KUU Konjac sponge buat mandi? Kali ini giliran mak nya yang kebaniran sepon buat mandi :)

*horeee*



The kind people di KUU Konjac Sponge Indonesia kirimin aku 4 tipe macem sponge yang menurut aku unik banget teksturnya. Yang kalo kata Mommy Hanna Anindhita, mirip krecek! haha!

Tapi iyah juga sih kalo dirasa rasa *halah*

My weight loss journey with Mary Chia..

Oh yes! I am a happier Momma.

Not only that I am already back to pre pregnancy weight..BUT I am already lighter than my pre pregnancy weight!



WOHOOOOOO!! Thank you to Mary Chia!

I super duper love their weight loss program.



Go and try their Intensive weight vaporizer treatment.

The vibration bed and air-pressure slimmer effectively promote lymphatic
drainage while sauna and full-body

I am BIOLEE ambassador

I am so excited and so super grateful for the opportunity to be Biolee Ambassador!
I mean, this thing definitely not happened for someone that hit the big 30 in age departments..and I was so grateful when they offer me the contract and hope that I will be on board with them :)

This is definitely the *achievement unlock* moment in my blogging journey, and I am ready for all the good thing that

Chacott flagship is open in Mandarin Gallery!

Singapore�s retail scene is set to excite as we welcome the opening of the first SouthEast Asian flagship store for Chacott and Freed of London in the well-placed Mandarin Gallery located within the bustling shopping hub of Singapore, Orchard Road.







Chacott and Freed of London are two of the most esteemed labels in the ballet world. Both labels have a rich history of producing some of

Have you heard about Diapers Cake?

I know that this post has been long overdue, but it doesn't stop me from smiling whenever I saw this photos - it just so pretty and worth to share..so I decided to blog about it.



A diaper cake is a fun and practical baby gift, perfect for new or
expectant parents. They are great for baby showers, hospital visits,
first month and office celebrations. They are made entirely of
disposable

My journey with Mary Chia..

Hellow yellow..now that I am back from Japan and Jakarta, I am going to update my Mary Chia journey with you :)



If you missed out my last post about how I love the antii cellulite LPG machine, I need to remind you again on how awesome is the treatment. If you have that fat lump under your bra wire on your back - and you can't wait to get rid of it! This is the treatment to go for!







The

[GIVEAWAY] - ZIAJA shower gel!

ZIAJA is one of the largest pharmaceutical companies in Europe
selling almost 50 million products globally every year. ZIAJA is present in 28
countries worldwide, including Japan, South Korea, Taiwan, the Philippines,
Vietnam, China and now Singapore!



They have a full range from face, body to hand skin care, and the kind people at Ziaja sharing these 3 body cleanser with me and now I am

Quality health outcomes depend upon the Social Determinants of Health

On the heels of the publication by the Center for Medicare and Medicaid Services (CMS) of how much money Medicare paid to individual physicians (discussed on this blog in Medicare payments to doctors: the big issue is the underpayment for primary care, April 9, 2014), we have revelations of inequity in Federal payments to health providers. A panel of the National Quality Forum (NQF), convened by the Administration to look at this issue, has determined  that payments for �quality of care� to hospitals under the Affordable Care Act (ACA) tend to reward those hospitals caring for higher-income patients and penalize those who care for the poor (Robert Pear, �Health law�s pay policy is skewed, panel finds�, New York Times, April 27, 2014). This cannot be the way we want to go, and thankfully that is the conclusion reached by the panel. It is, however, the NQF that developed these 600 or so quality indicators, and has not recommended adjusting them for the socioeconomic status of the patients that a hospital cares for (although it does adjust for severity of illness).

What is happening is that the measures of quality of care are largely not measures of what is done for patients in the hospital, but how they do after � are they readmitted shortly after discharge, are the diseases for which they are being cared for under better control or not, do they get follow-up care. The fact is that for a variety of reasons including money, education, transportation, and competing demands, poor people do not do as well as better-off people, even controlling for the quality of care that they receive when they are hospitalized. A number of panel members comment on this in the Times article, including NQF president Christine Cassel, who says �Factors far outside the control of a doctor or hospital � patients� income, housing, education, even race � can significantly affect patient health, health care and providers� performance scores,� and panel member Steven H. Lipstein, CEO of BJC HealthCare in St. Louis who adds �The administration�s current policy on adjustments for socioeconomic status are quite inadvertently exacerbating disparities in access to medical care for poor people who live in isolated neighborhoods. I�m sure that�s not what President Obama intended with the Affordable Care Act.�

These comments are true, but the thrust of the NQF�s comments was the unfairness to the hospitals. This is important as far as it goes � it is outrageous to pay extra money for �quality of care� to hospitals that care for the privileged and penalize those that care for the underserved. Many of the members of the panel and other commenters quoted by Mr. Pear focus on academic teaching hospitals, which indeed care for a disproportionate share of poor people; however, public hospitals (in those areas where they exist) are even more affected. But what is more important is how this issue illustrates the power of what are called the �social determinants of health�, the situation that people live in before they access medical care, and after they are discharged, have on health outcomes.

Health advocate and policy expert Kip Sullivan is more pointed in his comments on Don McCanne�s �Quote of the Day� for April 28, 2014. �The notion that doctors and hospitals are screwing up and will behave if they are subjected to punishment and reward by third parties is not new. The Code of Hammurabi (1750 BC) subjected Mesopotamian doctors to a combination of reward (more shekels) and punishment (cutting off of doctors' hands)�But even Hammurabi didn�t recommend punishing the patients.�  If hospitals that care for poor people are effectively financially penalized for doing so, they will (at best) be further financially challenged in providing that care, and at worst will do their best to not care for the poor to the extent that they can.

Why would the NQF and the Department of Health and Human Services (HHS) take such a position, one that seems both unfair and even mean? One might be tempted to suggest that rewarding the �haves� and punishing the �have nots� is what is usually done by government policy, but we would hope that, given its rhetoric on health care � and the creation of the ACA in the first place � the Obama administration would not be guilty of such intent. We get some better idea from Kate Goodrich, the director of quality measurement programs at the federal Centers for Medicare and Medicaid Services, who is quoted in Mr. Pear�s article as saying �We do not want to hold hospitals to different standards of care simply because they treat a large number of low-socioeconomic-status patients. Our position has always been not to risk-adjust for socioeconomic status within our measures because of concern about masking disparities, and potentially rewarding providers who provide a lower level of care for minorities or poor patients.�

Now, this sounds almost noble, like a values-based response to critics such as those on the NQF�s panel. However, the clear and obvious flaw in such logic is that hospitals have the power to change the lives of these patients in such a way as to decrease their risk for poor outcomes to be equal to, or better, than, those of higher socioeconomic status. They don�t, and to the extent that they could do more work in the community to help this situation, it would cost more money, so it is absurd that they be financially penalized. Dollars spent by government on health care should first and foremost be required to be spent on health, not on making money for providers (doctors or hospitals) who can by virtue of their location (and possibly other strategies) avoid taking care of the neediest. Hospitals should be judged and reimbursed on the quality of care that they deliver, equitably and without prejudice with regard to socioeconomic status, but cannot reasonably be judged on outcomes which depend on factors far outside the control of those hospitals.

The real issue is that people who are poor have a lot more to contend with than the services delivered as health care. It is not uncommon for our hospital to be treating a person with a bone infection made worse by their diabetes who needs 6 weeks of IV antibiotics. This can be delivered by a home health care agency, and most insurance will pay for it. But it becomes a problem if the person does not have insurance. And is even more complicated when they do not have a home. These people stay in the hospital, at exorbitant cost, for the whole duration of treatment. But would our quality measures be better if we only cared for those with homes and insurance? Would the hospital make more? Of course, as Mr. Sullivan points out, while the hospitals lose financially, ultimately it is the patients who suffer.

The social determinants of health are well-portrayed in the �cliff analogy� developed by Dr. Camara Jones and her colleagues,[1]and discussed in my blog of September 12, 2010, �Social Determinants, Personal Responsibility, and Health System Outcomes�. The care given by hospitals occurs at the bottom of the cliff, after people have fallen, but their risk, both before arriving at the hospital and in returning home, is that they are living so close to the cliff face; their housing is poor, their neighborhoods are dangerous and polluted, their schools do not educate, and food is often scarce and not nutritious.  In their study comparing health costs in the US and Europe, Elizabeth Bradley and colleagues discovered that while the US spends far more on �health care�, if you add in basic social service spending, the difference decreases, but that the US spends most of its combined health-and-social-service spending on medical care.[2](Discussed in a New York Timesop-ed, �To fix health care, help the poor� by Bradley and Lauren Taylor, and in my blog �To improve health the US must spend more on social services�, November 18, 2011.)

It is understandable that, given the political climate in Washington and state capitals and the flak that they took for ACA, the Obama administration does not want to put major effort into addressing the social determinants of health by developing programs to meet the core needs of poor people in our country, to prevent them from getting sick, to give them access to meaningful post-hospital care, to have health workers in communities, punish polluters, decrease crime, and limit health risks. Understandable, but not OK. And in the meantime, on this narrower issue, it obviously requires adjusting for socioeconomic risks for hospitals caring for the poor when their quality incentive payments are calculated.

But sometime soon we are going to have to address the core problems.

---

[1] Jones CP, Jones CY, Perry GS, �Addressing the social determinants of children�s health: a cliff analogy�, Journal of Health Care for the Poor and Underserved, 2009Nov;20(4):supplement pp 1-12. DOI: 10.1353/hpu.0.0228. Slides available on line at http://www.csg.org/knowledgecenter/docs/health/CamaraJones.pdf.

[2] Bradley EH, Elkins BR, Herrin J, Elbel B.,Health and social services expenditures: associations with health outcomes, BMJ Qual Saf. 2011 Oct;20(10):826-31. Epub 2011 Mar 29

Typical casual

Typical casual by elrica-diona featuring a black ringStripe top$51 - beginningboutique.com.auSemi Couture red pleated skirtfarfetch.comFlat shoesrockport.comDolce Gabbana studded handbagyoox.comLipsy black ring$20 - lipsy.co.ukCateye glassesamazon.comMineral face powder$37 - ry.com.auChanel lipstick$42 - harrods.comGuess fragranceguess.comchevron fabric, wallpaper, gift wrap, and decals -

STOP NYOLONG people!

Setelah berkali kali baca postingannya Arman yang photo familynya terus menerus dicolong orang..gw baru beneran ngerasain secara poto gw dicolong sama orang dan company yang menurut gw ga bertanggung jawab. Dan gw bawaannya uda pengen ngoceh ngoceh aja, padahal baru 3 poto yang kecolong..kalo gw jadi Arman, gw send virus ke email company ato orang yang nyolong kali.



Saban baca postnya Arman

Kegalauan akuh di malam hari..

Uda 4 hari belakangan, selama gw di Jakarta..gw beneran ga bisa bobo - biar seharian teler jagain ethan..tetep aja malemnya gw baru tidur jam 1.30am onwards. Kayaknya pas merem, banyak banget hal yang gw pikirin gitu..Jakarta, for some reason bikin gw bersusah ati gitu. Bukan soal macet en riwehnya ni kota, tapi more to people and things yang close to my heart tinggal di sini yang ga bisa gw liat

Japanese make up tutorial with Tokyo Luxey..

Hallo, sorry for my late posting!
I just got back from Tokyo and Hakone - and I must say I AM IN LOVE WITH JAPAN!
Everything there is just simply lovely. The people are VERY ( i mean VERY VERY) nice and polite, helpful, very welcoming and considerate.Although I don't speak Japanese except for Sumimasen, Arigato, Gomenasai, and Daijobudes, I still survive my one week in Japan.
I definitely will

Index to Medicine and Social Justice Blog, Year 5, Dec 2012-Nov 2013

Primary Care

Dec 23, 2012: Does AAMC have an answer for the primary care shortage? No.

Feb 8, 2013: Creating more family doctors: should we shorten medical school? How?

Mar 19, 2013: Can you be "too strong" for family medicine?

Jun 2, 2013: Primary Care Contributes More than Money....

Jun 9, 2013: Helping primary care help the health of all of us       

Oct 13, 2013: The role of Primary Care in improving health: In the US and around the world

Oct 26, 2013: Why do students not choose primary care?

 

Health Reform

Feb 2, 2013: Kansas, Medicaid expansion, and human rights

Apr 21, 2013: Payments for surgical complications: With a scalpel or a meat ax?

May 5, 2013: Medicaid Expansion: Do we care for people or not?

May 12, 2013: Hospital charge variation and Medicare equipment fraud: two forms of gaming the "non-system"

May 26, 2013: Medicaid expansion will leave out many of the poorest: What is wrong with this picture?

Jun 16, 2013: "Call the Midwife": If Britain could afford to create a National Health Service after WWII, we can now!

Jul 21, 2013: Changes in the RUC: None.. How come we let a bunch of self-interested doctors decide what they get paid?

Aug 4, 2013: Why poor people choose ERs: we need a system designed to meet everyone�s needs

Sep 29, 2013: What can we really expect from ObamaCare? A lot, actually.

Nov 17, 2013: Dead Man Walking: People still die from lack of health insurance

 

Health Research and Evidence

Dec 8, 2013: More on mammography: just because you don't like the results doesn't make research junk science

Jan 12, 2013: Mental Illness and Guns: A public health perspective

Jan 19, 2013: Weight and class: who is obese and why should we care?

Jan 26, 2013: The flu is a virus!

Apr 7, 2013: Research on disparities/inequities, in practices and communities needs much greater funding

Apr 14, 2013: Premature babies and informed consent: we need to do it right

Sep 7, 2013: President Bush's stent: inappropriate screening and care for the rich, nothing for the poor

 

Medical Education

Feb 8, 2013: Creating more family doctors: should we shorten medical school? How?

Mar 19, 2013: Can you be "too strong" for family medicine?

Jul 7, 2013: Why don't graduate medical education programs produce the doctors America needs?

Oct 26, 2013: Why do students not choose primary care?

Nov 3, 2013: Should Medical School last 3 years? If so, which 3?

The Health System and Social Justice

Dec 1, 2012: Gaming the system: Integration of healthcare services can just raise costs, not quality

May 19, 2013: Keeping immigrants and all of us healthy is a social task

Jun 16, 2013: "Call the Midwife": If Britain could afford to create a National Health Service after WWII, we can now!

Jun 22, 2013: Moving to Recovery By Design (guesy post by Robert Bowman, MD)

Jan 5, 2013: When is the doctor not needed? And who should take their place?

Feb 16, 2013: Creating team based care: are non-physician providers more effectively used in primary or subspecialty care?

Feb 23, 2013: Corruption and Scandal in the NHS: What happens when you introduce private incentives to public services

Mar 2, 2013: Squeezing the needy: a truly flawed financing system for healthcare

Jul 14, 2013: The State of US Health: improved over 20 years, but not nearly enough

Jul 28, 2013: The high cost of US health care: it's not the colonoscopies, it's the profit

Aug 4, 2013: Why poor people choose ERs: we need a system designed to meet everyone�s needs

Aug 10, 2013: Insufficient outrage: is health care about helping people or enriching providers?

Aug 17, 2013: Status Syndrome: an important determinant of health (guest post by Linda French, MD)

Sep 7, 2013: President Bush's stent: inappropriate screening and care for the rich, nothing for the poor

Oct 6, 2013: Critical access hospitals: Worth subsidizing to help save rural America

Nov 10, 2013: Does quality of care vary by insurance status? Even Medicare? Is that OK?

Nov 17, 2013: Dead Man Walking: People still die from lack of health insurance

Nov 23, 2013: Outliers, Hotspotting, and the Social Determinants of Health

Providers, Values, and Health

Aug 10, 2013: Insufficient outrage: is health care about helping people or enriching providers?

Aug 25, 2013: Physicians' role in controlling health costs: do no financial harm

Sep 1, 2013: Rand Paul on health policy: small brain and no heart

Sep 15, 2013: Competition vs. Coordination in health care: remember the patient!

Sep 22, 2013: Controlling the cost of health care by doing the right thing

Oct 20, 2013: The cost of medical care: bundling tests and blaming the victim

Nov 10, 2013: Does quality of care vary by insurance status? Even Medicare? Is that OK?

 

Other

Apr 26, 2013: Matthew Freeman Lecture and Awards, 2013

Bubble Perm from Salon De Choix

I got myself a Bubble Perm!

Yes, it's a new technology called Bubble Perm.



Before you start reading on the process, i just want to let you know that this is my favourite hair perm EVER! You will know why soon enough..:)



As I mentioned in the previous Salon De Choic post, I don't like straight hair.

I found with straight cut, my hair are most of the time in damp condition - unless I am

Medicare payments to doctors: the big issue is the underpayment for primary care

The Center for Medicare and Medicaid Services (CMS) just published how much money individual doctors get paid from Medicare. This initial version is without names, but undoubtedly the names will eventually be revealed. Enough information is available for Reed Abelson and Sarah Cohen, who wrote the article for the New York Times on April 9, 2014 �Sliver of Medicare Doctors Get Big Share of Payouts�,   to identify many of the specialties and locations. About � of all Medicare payments, the article tells us, go to about 2% of all doctors. �In 2012, 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, eye and cancer specialists chief among them, who received more than $4 million each that year.� The largest amount of money was accounted for by office visits, $12B, but this was for 214M visits, with an average reimbursement of $57, in contrast to the Florida ophthalmologist, or to the �Fewer than 1,000 radiation oncologists, for example, received payments totaling $1.1 billion.�

Much of the discussion in the article, and in the comments attached, relates to why so few doctors get so much of the $77B Medicare pays out each year. There are, obviously, concerns about fraud; not only is Medicare seemingly fixated on looking for fraud everywhere but there is good evidence that it has occurred, at least historically. For example a highly paid (by Medicare) Florida ophthalmologist is apparently linked to a previous Medicare fraud scandal in which there was some implication of New Jersey Senator Robert Menendez. �The Office of Inspector General for the Department of Health and Human Services, which serves as a federal watchdog on fraud and abuse for the agency, released a report in December recommending greater scrutiny of those physicians who were Medicare�s highest billers.� I would have to say that this is a much wiser, fairer, and probably more productive strategy than simply trying to find largely unintentional errors in coding for outpatient visits, or checking each hospital admission to see if it could have been an �observation�, which is reimbursed less because it is considered outpatient status, as is done by Medicare�s Recovery Audit Contractors (RACs, or as I have called them, bounty hunters). Also, as I have previously discussed, these efforts are harmful to the patient in a direct financial way; as an �outpatient�, a Medicare recipient in the hospital has much higher out-of-pocket costs than if they are admitted as an inpatient. This is, of course, why CMS wishes to limit some stays, but if a person medically needs to be in the hospital, Medicare should pay for a hospitalization, and not play these games that not only financially penalize the hospital and doctors but more importantly the patient.

The other big area discussed is whether, if not exactly fraud, there is substantial difference in practice (e.g., getting CTs before each procedure, using more expensive drugs, etc.) that some specialists who are highly reimbursed by Medicare are doing more of than others. In addition, the question is �are they doing more procedures� or doing procedures with less strict indications? It is worth looking at; there is no guarantee that, even if some doctors are doing more procedures, having looser criteria for them, using more expensive drugs and tests, that this is not the better way to practice, but there is no guarantee that it is the better way to practice. If some doctors are outliers in their specialty, and their practice characteristics �happen� to end up making them a LOT more money than others, then this is certainly a reasonable basis on which to look more closely at how they are practicing, and what is the evidence basis of appropriate practice.

A third issue is that many of the recipients of the most money from Medicare, particularly oncologists (cancer doctors) and ophthalmologists are using very expensive drugs, which they have to buy first and which Medicare reimburses them for. Thus, this skews their reimbursement upward even though the money (or most of it) does not go to the doctor, but rather to the pharmaceutical company. The article refers to a drug called ranibizumab, injected into the eye by ophthalmologists monthly for age-related macular degeneration. It is very expensive, as are many drugs which are made through recombinant DNA (a lot end in �-ab�) used by oncologists, neurologists, rheumatologists, and gastroenterologists as well. One comment notes that he as a physician only makes 3% on the drug. While it can be argued that this is a significant markup (for example, making $3000 on a $100,000 drug), and that this doesn�t include the doctor�s fee for administering it (substantial), it is unfair to count the full cost of the drug as income for the doctor. Of course, it is income for someone (the pharmaceutical company) which suggests there needs to be substantial investigation into pricing of these drugs. And, of course, if a physician is found to be using a lot of a drug where he (or she) makes a 3% markup rather than prescribing an equally effective drug (if there is one) where there is no markup profit, this would be a bad thing.

However, the most important thing revealed by this data, I believe, is the enormously skewed reimbursement by specialty. It is an excellent window into the incredible differences in reimbursement for different specialties, with the ophthalmologists, radiation oncologists, etc. making huge incomes while primary care doctors (and nurse practitioners) are making $57 for an office visit. This is major. The fact that Medicare pays so fantastically much more for procedures (and, as a note, it is likely that all of the doctors, including the 202 family doctors in the highest-paid 2%, are getting it for doing a lot of procedures) leads to private insurers paying similarly more. And makes these specialties very attractive to medical students because they are lucrative (and often, though not in the case of many surgical specialties, involve fewer hours of work). Which leads to fewer primary care doctors, and a dramatic shortage in this country.

Medicare could change this. It could dramatically, not a little bit, change the reimbursement for cognitive visits to be closer to the payment for these procedures. If it did, so would private insurers. If the income of primary care doctors was 70% of that of specialists (instead of say, 30%) data from Altarum researchers and from Canada suggest that the influence of income on specialty choice would largely disappear. More students would enter primary care, and in time we would begin to see a physician workforce that would be closer to what this country needs, about 50% doctors actually practicing primary care.

It is fine if CMS and the OIG look at these highest billing doctors to make sure that they are not committing overt fraud. It is also fine to look at them and see if they are using criteria for procedures that are not supported by current evidence, or doing too many other tests, or taking kickbacks. It is also a good idea to look at the cost of drugs, especially the portion going to the drug company, as well as the markup for physicians, and to re-present the data excluding that portion of the money the doctor does not get (goes to the pharmaceutical company) from their income.

But the most important result of this report should be to be shocked at the way Medicare enables the continued practice of reimbursing for procedures at such high levels, and to kickstart a complete revision of the Medicare fee schedule to bring reimbursement for different specialties into better balance.

That would be a great outcome!

Japan here we come!

Kami hendak berangkat ke Tokyo!

Gile ini bener bener ga ada rencana gitu loh ke Jepang, awalnya mo bulan Oktober ke Jepangnya..trus entah kenapa, maju ke April untuk liat Sakura.







Gw ma Bang Arip bakal sotoy mampus berbekal Tokyo - Lonely Planet guide, jalan sendiri ga pake tour kesono. Trus kita cuman bermodalkan bahasa Jepang " Sumimasen " untuk komunikasi..ntah apa jadinya lah disana.