Global∑os® (GlobalEOS)
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Global∑os® (GlobalEOS)
Designing innovative global healthcare programs and mechanisms by way of strategic administrative, management, HIT and concierge services
Curated by Brian Altonen
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Intelligent Design Theory

Intelligent Design Theory | Global∑os® (GlobalEOS) |
Intelligent Design Theory: What’s The Difference Between Intelligent Design Theory And Creationism? Many living systems show complicated planning. There are thousands of living systems that cannot...
Brian Altonens insight:

Ahh, this "Intelligent Design" link courtesy Beverly F. and Sam Kaplan via LinkedIn.


For "The Inquisitor", with . . . an inquisitive mind.


Reminds me of scientism and science, and their conflicts with everything else -- these are why we have "diversity" in our private, public and professional environments.  


What one cannot explain through science, the other is on standby for.



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Gini Coefficient? Am I an outlier in that study?

Gini Coefficient?  Am I an outlier in that study? | Global∑os® (GlobalEOS) |
So wrong.

Thanks to @[170394193013257:274:Real Truth Now] for the image.
Brian Altonens insight:

A number of versions of this illustration with its pointed statements seem to be going around.  As a statistician, I believe that adding the Gini Coefficient to this logic makes more sense of it.


The Gini coefficient was created by the Italian sociologist Corrado Gini and described in his 1912 essay “Variabilità e mutabilità" (transl. "Variability and Mutability"), C. Cuppini, Bologna, 1912).  It was  a measure of the difference between the two ends of the spectrum in a society where social inequality prevails.    

The amount of inequality that exists is defined by the distance between some straight line and a curve.  That space between equality and inequality details how finances are secured and spent.  The focus of this curve is on the middle class, and which sectors of the middle class have significant savings in the bank versus those who do not.

Theoretically, the more savings, the more prepared you are for financial disasters, unexpected increases in healthcare costs, and ultimately retirement.   Those at the high end of this spectrum have substantially more savings available to them for improving the quality of life in an older age.  Those in the middle class have a curve that is currently fluctuating, making their end stages in life more akin to those of the lower class.  This could result in the shift of a circular, regularly accelerating curve of inequality into an exponential curve of inequality, as dissavings are reduced significantly for the middle class, making the middle class live out the end of their life much like the surviving lower class.


A brief discussion of this is found at 


What Occupy Wall Street And Gini Coefficient Say About Inequality
By BRAND NIEMANN.  November 23, 2011 at :



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Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011 | Global∑os® (GlobalEOS) |

Where were we with immunizing our children 50 years ago?  


This doctor's office sign is from the 1960s.

Brian Altonens insight:

Link to the 'Clinical Infectious Diseases' article on the recent measles outbreak in the Hudson Valley, New York.  


Jennifer B. Rosen, Jennifer S. Rota, Carole J. Hickman, Sun Sowers, Sara Mercader, Paul A. Rota, William J. Bellini, Ada J. Huang, Margaret K. Doll, Jane R. Zucker, and Christopher M. Zimmerman.  Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011.  Clin Infect Dis. (2014). doi: 10.1093/cid/ciu105.

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Remembering How to Fight Measles

Remembering How to Fight Measles | Global∑os® (GlobalEOS) |

Outbreaks from New York to California chart the return of a vanquished disease.    For more on the current outbreaks in NY, see


Brian Altonens insight:

About ten years ago there was a significant lapse in immunization rates due to a shortage of vaccines.

In the line on this graph the drop in completed immunizations that ensued for the annual HEDIS review is evident.  

The surprise with this review however was the rapid return to pre-shortage practices.  By the time this shortage was over, both the children and parents eligible for the next HEDIS had changed as well.

In other words, in spite of set back, the system itself underwent minimal changes in intervention activities, clinical performance and long term HEDIS accomplishments.  

A measure of success is not a great year, but two or three great years of high level performance in a row, hopefully followed by continual growth for years to come.

To learn more about the best programs in U.S. healthcare, go to

This particular story about Denver Health is retold at



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How Your Social Media Profile Could Cost you Your Next Job - SocialTimes

How Your Social Media Profile Could Cost you Your Next Job - SocialTimes | Global∑os® (GlobalEOS) |
Think twice before posting about religion or politics on social media. A new study reveals how online information affects hiring manager bias.
Brian Altonens insight:

LinkedIn really is a social scene.  It is mostly for the employed and those in search for work.  It is a place where personality defines who you are, where you want to be, what you really can do.  It is rarely a place where co-employees and potential future employers really learn much about who you are.


The fact that LinkedIn is mostly a form of social media for the workforce means that when it is used to identify future workers, all that will really happen is that those who are of the right social status and behavior are going to get those jobs that are out there.  LinkedIn is not the place to go to when searching for someone with real work skills.


In academia, the best place to search for someone with the knowledge base and skills needed for research is a site called  ResearchGate is where the "geeks" socialize and create an impact on each other.  By communicating with someone at ResearchGate you will come face to face with people who understand why you used n-1 in your denominator instead of n, or why you used sigma instead of theta for your final metric, or why you excluded outliers this time through but not the many times prior in your work.


Of the five negative influences noted on this page, one stands out for the millennium generation, those young adults now leaving college and comparing what they know with how far behind our businesses have become.


Managers are currently judging the more skilled of graduates based on their social media.  That's one step down from trying to understand the knowledge base these new recruits bring with them to an established company.  


Today's companies fail because they are behind the times.  Every "geek" knows that about businesses.  Businesses have focused too much on their assets and income and forgotten to pay attention to the customer or consumer.  That's like kissing a gift horse in the mouth in today's industries.  Today's industries die due to failure to expand or improve.  Even though that think they've improved, the fact that they have not taken on new ideas and new skills, means they will soon fall behind like their former competitors.


Change is good for business.  Especially when it requires that older managers step away from their positions and leave the field they are no longer experts in.  


This is why young managers who are entrepreneurs will succeed where everyone else has failed. Ask the creators of sites like LinkedIn, Facebook, and the good ole Myspace.   LinkedIn right now is the place where business people can avoid be in their business.  It is just another site where workers socialize and pass the day, without many accomplishments to vouch for in the end.  


The most likely to succeed in a LinkedIn setting are the status quo, another average member of the team, a typical worker. Not those with the freshest of minds, the best knowledge, those young graduates who have the potential of achieving more than the companies that consider hiring them.  Nor are the innovative respected much by LinkedIn, which is a good sign if you wish to be truly different with what you do.

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Big Ten Innovation Killers

Big Ten Innovation Killers | Global∑os® (GlobalEOS) |

Did you ever wonder if your company was really as "innovative" as it claimed to be before the job offer?  How many years do you expect to work with your current employer?  The more innovative a company is and the more you are aware of its innovation(s), the more likely you will make it past the ten year mark with a company.

Brian Altonens insight:

A ten year survival rate with a company is incredibly good based on today's lack of long term success in the business world.  For each of the ten problems with companies that have rapid employee turnover rates  above, shave one year off that ten year plan survival rate you had when you begin your job with a company that you felt especially comfortable with when you said "yes!".

Companies that do not integrate the company's future with that of its employees are doomed to failure.  Rapid rises followed falls in success always happen when the corporate environment changes, and workers are no longer secure in their setting.  When the popularity of a company to its customers falls, so does the faith of its its fellow workers.

The above ways to evaluate a company seem fairly generic in some ways, different people have different attitudes about whether any of the above problems exist or not.  But it is not the truth that matter, it is only the attitude that is generated by the workers.  A disgruntled employee, or an employee who feels that due to language, race or topics of interest  he or she is not included in all teamwork related activities, is unlikely to tolerate this behavior for too long.  

Yet all companies in some way, shape or form misbehave according to the above 10 features.  The average length of stay of employees in your department or grade of work tells you how many of these ten misbehaviors a company and/or the department hiring you engages in--the question is which of these ten are the worst? 

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Statistics – February 2013 | Penang Monthly

Statistics – February 2013 | Penang Monthly | Global∑os® (GlobalEOS) |

MEDICAL TOURISM REVIEW.  MEDICAL TOURISM RECEIPTS/REVENUE IN MALAYSIA, 2000-2011.  Medical tourism traditionally involved tourists cum patients from developed countries travelling to normally less developed countries to get treatment . . .

Brian Altonens insight:

Additional information on the very successful industries in Asia can be found at:


Penang Monthly (source for charts and graphs above) --



Asian Medical Tourism Forecast to 2015


Is Medical Tourism the Future of Health Care? by IB Times (source for photographs above) --


Challenges and Medical Tourism Facts in 2013 --


Wellness Tourism vs. Medical Tourism - the Difference --



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The truth about reportable adverse events -- online

The truth about reportable adverse events -- online | Global∑os® (GlobalEOS) |
At DigiPharm 2010, Creation Healthcare will be presenting groundbreaking research into adverse events online. In this article, Paul Grant provides a first look at brand new insights to inform your ...
Brian Altonens insight:

Free online, open source GISing can be pretty informative.  


It may be the only way we have the chance to see spatial relationships when there are limited resources and limited funding at hand.


Healthcare Management manages to fill the gap where otherwise this work would not be done.  For example . . . 


"Creation Pinpoint studies  have highlighted a range of Healthcare Professional (HCP) behaviours on public social media. In this post, using the topic of chronic obstructive pulmonary disease (COPD) as an example, I will outline some of the most commonly-seen behaviours, giving an insight into what may be important for HCPs online."

For more on this site, see

For more examples:

 . . . 

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Defining and Stratifying Risk based upon ICD-Culture Relationships. Core Competencies for Global Healthcare.

Defining and Stratifying Risk based upon ICD-Culture Relationships.  Core Competencies for Global Healthcare. | Global∑os® (GlobalEOS) |

Recommended read: 

Aretz, H. (2011). Some thoughts about creating healthcare professionals that match what societies need. Medical Teacher, 33(8), 608-613. doi:10.3109/0142159X.2011.590389


  "Healthcare is becoming increasingly complex across the globe; technology, delivery models, economic requirements, demographics and the epidemiology of disease are changing at a rapid pace. . . Rather than being one participant, possibly a reluctant one, academia should become the catalyst for change, the hub for stakeholder interactions, and the breeding ground for the new healthcare force."

Brian Altonens insight:

As recommended by Harvard professor H. Thomas Aretz in the cited journal article on display, and based on 15 years experience in cultural medicine and managed care, I developed this model for developing culturally-sensitive managed care plans.   


The program I designed uses qualitative and quantitative analytic techniques including several new software tools to analyze and review the care management programs developed for meeting the needs of specific groups.  The major difference between this program and many similar program out there is the degree to which I focus on the four classes of ICDs that need to be evaluated for this type of population health study.


This is the first plan to focus on a multicultural health managed care health perspective, based on a a literature and popular press (incl. news) review. 


Some of the metrics required for this program include:


1.  SES and ethnic/demographics-based community health demographics and mapping

2.  an ethnicity focused patient satisfaction survey program tool development step

3.  the determination of potentials for local culturally-bound conditions

4.  the determination of potentials for local culturally-linked diseases

5.  the determination of potentials for local culturally-related high prevalence rates

6.  the determination of potential for local culturally related public health and infectious disease issues

7. a grounded theory way to analyze survey responses and patient healthcare satisfaction interview/query results.


Like many of my projects, GIS is involved, but not required.


The first parts of this work are covered in detail on several pages, beginning at



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How countries compare - Expat Explorer Survey - world's largest expat survey from HSBC Expat

How countries compare - Expat Explorer Survey - world's largest expat survey from HSBC Expat | Global∑os® (GlobalEOS) |
If you were moving abroad, what would you want to know? Find out the results from the largest ever global independent survey of expats. Gain a unique insight into how expat life differs across the globe.
Brian Altonens insight:

"The customer is always right."  


As a customer, the patient becomes the dominating factor in health care.  When the product is no longer sufficient, the customer goes elsewhere.


This review of the results for Expat Explorer Survey details the quality of life.


Malaysia ranks 14th in this review, the U.S. ranks 21st.  Now if the comments penned by surveyors became the motto,  for Malaysia that would be "HAVE AN OPEN MIND AND TREAT ALL PEOPLE AS YOU WOULD WISH TO BE TREATED", for the US it is "FOLLOW YOUR HEART AND EXPECT THE UNEXPECTED."

If we focus just on two things--Health Care Quality and Work--the U.S. ranks at 22nd and Malaysia 17th.   If we remove income from this metric, the U.S. is 16th, Malaysia 11th.  

Organizing healthcare, foodways, local work environment, fitting in with the local culture, integrating within, feeling welcome at work, organizing finances, setting up school for your children, were all additional social influences that resulted in scored that favored Malaysia.  Situated between Malaysia and the U.S. in term of scores is Singapore, a country that recently became well known due to a newsworthy case of expatriation.  Switzerland, Bahrain, Belgium, India, Indonesia, Argentina, Qatar and Turkey also scored better.   Cayman Islands scored first.   

In all, 37 countries were compared.  The U.S. ranked 22 out of 37, or at approximately the 59th percentile.  Expendable income was the primary factor that advanced the U.S. scores past its second place position relative to the quality of life high scorers.  

In terms of health coverage and quality of services provided, the inference here is that in spite of low ranking in terms of cost for care and quality of care, being the breadwinner still pays off for now.  

Regardless of the mid-range overall quality of life the 59th percentile ranking for the U.S, represents to us, for a while at least we are willing to tolerate poor health services and probably poorer health at the expense of remaining somewhat fluid in our cash flow defined style of living.  Working against us of course in this low ranking quality of care atmosphere and its impact on our longevity in the decades ahead.

It costs money to stay alive into and past the octagenarian years in the U.S.  Elsewhere it is a self-chosen style of living that makes us live longer and remain highly productive.

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Dancing with the Devil: Health, Human Rights, and the Export of U.S. Models of Managed Care to Developing Countries | Cultural Survival

Dancing with the Devil: Health, Human Rights, and the Export of U.S. Models of Managed Care to Developing Countries | Cultural Survival | Global∑os® (GlobalEOS) |

Brian Altonens insight:

As the idea of managed care trickles down into the global economy, a certain amount of resistance is developing in the WHO versus USAID (United States Agency for International Development).  At the most extreme end of this problem, we are reminded of those on-going indigenous rights messages that have been published over the years . . . or perhaps decades.


One particular problem that needs review is the notion that US managed care could become one of the options out there for care provided in other countries.  Such an argument is driven mostly by a circular line of reasoning.  


The reason such offers are considered is that many leaders perceive the other side of the fence to be in need of their services.  Yet, individuals who turn to medical care being practiced in other countries often do so because they feel they are not finding what they need, such as less expensive care that is more befitting of their personal and cultural beliefs.  Likewise, the reason people leave the US options behind also revolves around these issues--such things as they don't like the cost for such a service, or it does not fit their personal needs and philosophy, ot they don't like or trust its quality, or how it selects its services (prescription drug availability and licensure of certain procedures), or they simply don't wish to engage in it due to what they believe in (a rarer claim).


Most of the reasons for fighting a globalization of western managed care are probably quite similar to why governmental systems themselves operate differently from one other in different countries. The standardization and globalization of various cultures are not well respected.


"Dancing with the Devil" is a fairly strongly worded essay on the topic on "westernizing" (in the managed care way) global medicine.  Excluding the grammatical choices made by its author, Neillkevin Gerard, many of these concerns he voiced are absolutely correct.  


". . . public health theorists confidently predict that adopting U.S.-style practices merely involves some universal formula of decentralization, privatization, and software application on (somehow) standardized information systems. The plural health systems in many developing countries are not so easily harmonized"   - (See more at:


Not that there is anything to distrust about such changes.  The problem is that such a health care system, as it exists back home, cannot manage its own cultural medicine coming in from each of the four directions, in particular where this management is most needed.


Promoters of this new managed care paradigm are just as responsible for holding to UNESCO and WHO guidelines as any other country is.  For this reason, compromises need to be made, not all that "works at home", is equally "functional" abroad.


For the international take on this see: ; , ; ,



For the mapping of global health:

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429.83 - Takot subo or "Broken Heart Syndrome"

429.83  -  Takot subo or "Broken Heart Syndrome" | Global∑os® (GlobalEOS) |

Ξ  This research was initiated during my demography research of cultural medicine in the graduate medical geography and public health programs.  Back in 1998 a Pacific Rim study was performed ...

Brian Altonens insight:

My first interactions with various cultures began of course during my pre-med and medical school years on Long Island and in New York City.    The most influential years came on the west coast in Portland, over the next 20 years.  


There was this definite impact generated by the distance between the Pacific Northwest and the East coast.  This is perhaps why Oregon (and Washington) managed to develop a combined and accredited four year Traditional Chinese Medical/Acupuncture School for the first time in this country and its related, but separate, also fully accredited Naturopathic Medicine School.


It was the commercial history of the Pacific Rim however that played the most important role in these differences, this was emphasized throughout my years of Medical GIS/public health researching, teaching and schooling in Portland.  SUNDS in particular was a major concern in Portland due to the in-migration of Vietnamese, Laotian and Cambodian populations during the later years of the Vietnam War.  Surprisingly this concern was still around in 2000 when I had to design a cross-cultural research project on Laotian population care that was both qualitative and quantatitive .  


This review led to the following pages on how to more fully develop a cultural medicine public health interventions program in the U.S., beginning with:


The best approaches to cultural health require projects devoted to qualitative methods and the use of grounded theory.


A related overview of culturally bound, culturally-linked and culturally related diseases (this latter is what we hear the most about), is at:


Another page on the same but with a different twist is at  :

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International Medical Insurance | Global Health Options and Insurance Providers | Top 10 Countries

International Medical Insurance  |  Global Health Options and Insurance Providers  |  Top 10 Countries | Global∑os® (GlobalEOS) |

BEST ADVERTISEMENT -  -  "International medical insurance from Cigna Global Health Options. Get a quote and buy online."

Brian Altonens insight:

International health insurance is another venue for expats.  Examples of informatives sites and insurance providers on the topic include:


The recent popularity of this market trend led to the following photo essay on the top 10 expat countries:

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Wealth Inequality in America - YouTube

Infographics on the distribution of wealth in America, highlighting both the inequality and the difference between our perception of inequality and the actua...
Brian Altonens insight:

One of the things about costly health care is that it drives us away from doctors offices, clinics, and special treatment facilities, and towards other methods we seek out, in search for less expensive care and the different forms of care that we think we need.  


It used to be that in the U.S., if you were dissatisfied with the MD you went to the DC (chiropractic) or DO (Osteopath).  Then it became the acupuncturist and traditional Chinese physicians, or perhaps a homeopath (as certification for an MD or not), the local herbalist, PA, midwife, whomever.  Now our choices are in the hundreds.  


Why is there such a wide variety of choices that we take so seriously?


Regular medical care is quickly becoming so expensive that only certain people can afford it in its entirety.  So we pick and choose what medicines we will take, what forms of therapy we'll endure, what recommendations we will follow in order to stay healthy.  For every recommendation we do not take from a regular clinician in the allopathic profession, we usually have an alternative out there to abide by instead--one that we read about in a book, or someone we know who promotes a different plan, whom we plan to see in the next month or two.


Recently, the medical tourism option came to be.  Now we have the option of travelling out of this country to receive the same care in a more affordable setting.  With the rise in cultural diversity in this country,  don't be surprised if this becomes a regular experience that most families experience.   No longer is there the DC, DO, PA, LMT, LAc, "MH", ND, LNP, or expert in TCM to fall back on.  MDs provide these treatments in the other countries, even some who practice in the US as well.


Soon, wealth may no longer be required for you to experience your best human potential / human health potential.  

Brian Altonen's curator insight, May 15, 2014 10:57 PM

Where does the cost for healthcare and health insurance relate to all of this?

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House rejects Obamacare expatriate bill (April 10, 2014) -- Expats and the PPACA

House rejects Obamacare expatriate bill (April 10, 2014) -- Expats and the PPACA | Global∑os® (GlobalEOS) |

Expats need international health insurance. People who do not qualify as an expatriate need domestic insurance as well by March 2014.  


The recent arguments concerning, and rejection of expat care as a part of Obamacare, are reviewed at



Brian Altonens insight:

About a year ago, a classmate of mine in the MD program at a NY medical school (we were classmates and engaged in the same internship activities exactly 30 years ago) told me that he was practicing surgical care on his urology patients in the Caribbean.  Initially, I was very surprised by this claim.  He was one of the more renowned surgeons of the region in lower New York, and had just accepted a Chair position at one of the more elite hospitals offering surgerical care in the form of cryosurgery.   

When asked about his Caribbean venture, he said it had to do with the cost for his procedures in this country.  It cost one quarter the amount down in the Caribbean Islands, and due to the environment, the trip down there offered his patients a recreational recovery period as well.  In total, including the cost for a one to few week stay, the cost for the entire trip was less than undergoing the same bladder or prostate procedure down in the Big City.  More importantly, the quality of care where he worked and the overall recovery rates were not at all compromised by where he performed his procedures at these much lower costs.  He then told me about 4 more of our classmates and colleagues whom we attended classes with were also engaged in these venues down south.

Now, a year later, a friend of mine from high school decided to remove to Costa Rica to live out her retirement years.  Her choice was due to health care options available to her and the lower cost of living down in Costa Rica.  It offered her more opportunities to undergo expanded care when the time came, unlike the increasingly expensive health care options she was facing in the U.S.

I have to say, that in terms of costs, I agree with her.   Who wouldn't think that retiring elsewhere would not only allow you to make better use of your retirement savings, but also improve upon the quality of life and offer you more social and economic potentials!?   


According to her, the words for the day are "Costa Rica, here I come!'

For more on these programs and their health and "fringe" benefits, see the following:


5 Things to Know About Obamacare and the Impact on US Taxes for Expats.  (April 23, 2014).


Emily Buchanan.  5 Things You Should Know About Expats in Emerging Economies. (April 7, 2014)


ZACH DYER. LA PURA VIDA.  Costa Rica leads Latin America in Social Progress Index  (APRIL 5, 2014).


David McKeegan.  Obamacare 911- What US Expats Need to Know About Coverage & US Taxes Abroad Vote thumbs up! (2013).


ACA – Obamacare’s Effects on American Expats Living Abroad.   (2013).


Living healthy in Mexico: Insurance, health care and Mexico's medical tourism - a resource page.  (2012).


Medicare Coverage outside the United States (U.S. Government Publication).


Paige Winfield Cunningham. House rejects Obamacare expatriate bill — Sebelius to Senate Finance this morning — More kids get covered — LePage vetoes Medicaid expansion. (April 10, 2014).




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Mom Whose Child Died of Chicken Pox Advocates for Vaccines

Mom Whose Child Died of Chicken Pox Advocates for Vaccines | Global∑os® (GlobalEOS) |
Experts Say There Are No Gray Areas When It Comes to Vaccines
Brian Altonens insight:

Some old footage of mine on where the diseases that our children are immunized against demonstrated recent cases in EMRs.  .  

Some of these ICDs such as documented "small pox cases" are probably due to coding errors, mistaken diagnoses and "rule outs" placed in the EMRs.  

Others, like polio, have a well defined spatial epifocus, not at all randomly distributed, that is still in need of an explanation.  

Some of the immunized diseases still recurring in the U.S. demonstrate outbreak regions where small case clusters are formed every now and then, such as diphtheria.

Common childhood problems like mumps, far from being eradicated, still demonstrate a relationship with population density.

Chicken Pox is the most accepted. widely distributed potentially immunizable disease that is well documented using this 3D mapping method.

This was the first of a series of 3D mapping videos I produced for US disease patterns using a set of newer algorithms, designed to produce 3D surface images, instead of point patterns.  

It can be corrected to local population age-gender features, and applied to mapping any medical or healthcare statistic, including costs, frequencies, age-gender adjusted prevalence, accident related statistics, and human behavior features.

The 3D video of immunizable diseases can be viewed at

One of several pages I have devoted to this health concern is at


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Why Employers Will Stop Offering Health Insurance

Why Employers Will Stop Offering Health Insurance | Global∑os® (GlobalEOS) |
Dr. Ezekiel J. Emanuel makes the case that freeing employers from the burdens of providing health insurance is a good thing.
Brian Altonens insight:

If this is true, the current plans for changing the U.S. healthcare insurance programs could very well be a last attempt, a test of the value and sincerity of current leaders in U.S. healthcare insurance system.  

As businesses continue to struggle with the rising cost of health care, insurance companies will continue to lose their grip with their customers.

A Global Health Insurance option is at most a few years away, meaning you could soon find your insurance plan on the internet, and if necessary, opt for a less expensive program provided by a business not born on U.S. soil.  

The option of international care, that is to say receiving actual care from another country because it is considerable cheaper (in spite of travel costs--and besides, you could use the vacation!), or just the recommendations needed to opt for the expertise of someone from another country, who costs much less than a U.S. diagnostician.

According to this recent article posted on the internet, international health care option are just around the corner, and businesses are facilitating this transition in healthcare delivery..

If true, this could be a final blow to insurance companies now struggling to make end meet meet in terms of requirements for the new health plan.  

If this transition away from U.S. health insurance companies continues to grow at the speed it is projected, you will soon be making your own decision as to whether or not to pay into a health insurance program.  According to Robb Mandelbaum, the author of this news item, this is going to allow a substantial number of healthy people at a young age in their career to avoid having to pay for healthcare.  In turn, this means less income to the insurance companies that many feel are charging way too much for members who are overall very healthy.  The employers of these younger individual will certainly be happy to hear such option become possible.

In exchange for making you the chooser of your fate, your salary will of course increase, probably according to whatever the employer feels your health insurance is "worth" to you at whatever age you are.

If this happens, insurance companies will also have to regain the trust and confidence of whatever members they can, and seek out new ways pull in new members.

Once companies make this transition, the self-defining, self-insured will have more freedom in choosing the next path they want to take as personal health specialists.

This means that the current rising cost for health care will not work in favor of many standard insurance companies.  The attached higher costs for insurance linked to insurers, is going to put a hole in that balloon they have used to keep traditional health insurance coverage alive for the past two decades.  In short, the quality of insurance has but a few years left to prove itself and the companies capable or not.

And they will not only have to truly be capable and willing to lower their costs, and make effective changes, they will have be able to convince the many who left them over the years.  They need to prove to us that they can perform according these new and fair business standards.

The failure of healthcare occuring now is not good evidence for success in our evidence based healthcare system.  It only shows us how limited insurance companies have been with taking full responsibility for the quality of care that could exist right now.  The unethical business decisions will have to go away quite soon, or before we know it, the dearest members in the U.S. healthcare system will simply search for better providers of healthcare insurance.  It will be up to the patient to determine which insurance companies are good and which are not, even if it means finding your own outside providers from other countries that support those non-traditional avenues you might want to take. 

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The innovator's dilemma

The innovator's dilemma | Global∑os® (GlobalEOS) |

For every ten people or more companies in health care, there is one potential innovator.     Of these nine percent, less than one third have a chance of making it.    

Brian Altonens insight:

Some innovations in health are tough to recognize once they're developed.   EHR/EMRs,  Big Data plans, and the plans for a Cloud are some of the latest innovations in health that actually relate to plans first discussed in detail decades ago, during the early 1970s.


Big Data, the goal of making EMR accessible to everyone, and the development of a way to analyze quality of care in order to reduce costs, are the three primary primary goals that health care technology needs to strive for over the next few years.    


Not only are these changes a sign of whether or not we support innovations as a company, they also tell others how much we are what we claim we are when we discuss these topics.


When electronic invoicing entered the international market scene, the United States was average in how it responded to this new technology.   The success of this EXCHANGE network came due to the support of European companies, not United States activity.    


The same could be true for health data in the United States and how we use it to deal with the needs of patients and the healthcare industry.   


According to  Mikkel Hippe Brun in his Feb. 27, 2014 article, "The Innovator's dilemma",    


"The solution ultimately exists in the adoption of one, shared open platform. Only open models will realize the vision of everyone exchanging business data fully electronically." 


The same is true for the U.S. healthcare system.  


As detailed in the graph provided in Brun's article, each time a company discusses its desire to meet or not meet the requirements for improving healthcare in 2014, the leaders and employees of this company need to ask, "is our reaction to this recommendation that of a leader, an average business, a developer, or a lagger?"   


Concerned that you're a lagger?  Our barriers to adopting new technology are discussed at


Think you are an innovator?  The chief signs of an innovator are discussed at


See also "5 Inspirational TED Talks Every Healthcare Professional Must Watch."  July 22, 2013 by AIMSEDUCATION, available at


How company age, employee age, and development of new products/new resources, impact the growth and stability of your personal industry favorites (hopefully including where you work), see the temporal models of product innovation presented at


This could explain why some of our oldest insurance and healthcare industries are slow to accept change and move forward.  


Finally,  'Accelerating Quality Improvement in Health Care.  Strategies to Speed the Diffusion of Evidence-Based Innovations', by NIHCM, 2003. reviewable at

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Indonesia Health Insurance for Expats

Indonesia Health Insurance for Expats | Global∑os® (GlobalEOS) |

Learn about Indonesia healthcare and how you can cover yourself with international health insurance.

Brian Altonens insight:

Expatriation is one of those social Darwinian behaviors people have.  Quality of Care and Quality or Service are really the only inhibitors of travel to another country for more affordable care.  It used to be the case that only the well insured, the well paid, and those with family ties to other parts of the world.

But the idea that culture is why you choose this route has been replaced by your realization that earnings and finances are in your favor, and ultimately your employer's favor, should you travel abroad for your special health care needs.  

This is what big businesses are now having to contend with, due solely to the incredible high costs for health care in the United States.

When it comes to trying to determine if an $5,000 trip to another country, including the $1500-2500 cost for care   is worth avoiding that bill of $10,000-15,000 for the same care in the United States, why hesitate?

You deserve that week off, be it for "vacationing" and/or medical tourism.  If you are working for a company focused on its own finances and the cost for insuring its employees, you should receive the support you need to engage in .expatriate care.  

Due to the internet, the internal health marketplace, and savvy institutions with smart CEOs now operating in other countries, important surgical and medical skills, up to date education and the absence or presence of up to date technology, are no longer the main reasons for NOT receiving high quality care elsewhere in the world.

Brian Altonen's curator insight, November 1, 2013 11:11 PM

Plans for an integrated health plan in Indonesia were developed years ago by the World Health Organization.  The following goals and plans for operation were established:




1)  To define, lead and initiate a health-oriented plan for national development

2)  To maintain and enhance individuals, families, and public health, along with improving the health of the environment

3)  To maintain and enhance the quality, equitability and affordability of health services;

4)  To promote self-reliance in achieving good health


Plans to implement


a)  Engage in social mobilization and community empowerment

b)  Improve community access to quality care services through a revitalization of the basic health care system, the development of effective and efficient networks, and the implementation of a quality assurance and quality improvement program

c)  Increase access to and quality of health care provided by the implementation of policies, laws and regulations

d)  Improve the surveillance, monitoring and sharing of health information and the develop a system of communication that increases community participation and more timely reporting of health problems

e)  Design a program that helps to facilitate services when and where they are needed, in a timely fashion, and provide additional funding for such services where needed, to assist in any necessary health related communications, to provide information systems  with sharing potentials and to establish emergency or disaster preparedness plans for implementation new epidemics or endemics emerge or natural disasters take place.

f)  Develop a program that provides a steady and reliable source for health care financing, with a strong stakeholders system incorporating both the public and private sectors


Sounds much like a managed care plan? 


This plan is from the publication Health Indonesia 2010, a document published in October 1999 (link: 


Fifteen years later, 2014, Indonesia now offers remarkable health care options for United States expats - -

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A Prima Care Medical Resort in ICELAND . . . U.S. Medical Tourism

A Prima Care Medical Resort in ICELAND . . . U.S. Medical Tourism | Global∑os® (GlobalEOS) |
Brian Altonens insight:

For Iceland, it is not so much cost as it is waiting time.  Being place on a waiting list and drawn out approval processes are just two reasons people go elsewhere for certain healthcare services, especially when quality of life and one's ability to remain active and employed are at stake.


This brief article points out the following:  


"The global demand for medical tourism is expanding. It is currently a $40 billion industry growing at a CAGR of 15%. According to Deloitte Consulting, medical tourism originating in the US could jump by a factor of 10 over the next decade.


A 2008 McKinsey Report projected that the medical tourism industry gross revenue will reach $100 billion by 2012"


. . . . 


"In an effort to control rising costs, there are now a growing number of insurance plans in the US that are beginning to cover treatment for major surgical procedures in other countries. In our other target markets of UK, Germany, Nordic Countries, The Netherlands, and Canada, waiting times for joint replacement can currently range up to 2 years. As waiting times for these procedures continue to grow due to aging populations and more active lifestyles, there is an increasing willingness on the part of insurers to pay for services provided abroad."

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Worldometers - real time world statistics

Worldometers - real time world statistics | Global∑os® (GlobalEOS) |
Live world statistics on population, government and economics, society and media, environment, food, water, energy and health.
Brian Altonens insight:

Live counting is posted, based on traditional informatics sources.


For example, rate of number changes right now suggest: 


$10 trillion public health expenditure per day. by the end of today.


A more than 2:1 birth: death ratio today.


Nearly $400M spent per day is spent that is related to obesity.


More than 1 trillion is spent per day on illegal drugs.



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Will Obama's health care plan mirror the 1994 Clinton failure? -

Will Obama's health care plan mirror the 1994 Clinton failure? - | Global∑os® (GlobalEOS) |

In 1994, universal health care was a key policy plan for then-President Bill Clinton. It eventually failed.  [CNN, 2009]


Reliving the past – a SNL skit on the national healthcare crisis, 1994.

Brian Altonens insight:
History repeats itself, and that's one of the things that's wrong with history.
Clarence Darrow

"History Repeats itself, and that's one of the things wrong with history."    .   .   .   Clarence Darrow.


History repeats itself, and that's one of the things that's wrong with history.
Clarence Darrow

Suffice it to say, we are reliving the past. 


It is important to point out, however, that there are just two things that the Universal Health Care Act proposal of 1993 and the current Affordable Care Act have in common:  


Congress and congressional leaders . . . and most of the same health insurance companies.


If there is anywhere to assign blame . . . blame those who repeat their bad habits.  


See The Health Care Plan of 1993, at



and the SNL skit of 1994 :

Brian Altonen's curator insight, November 19, 2013 6:29 PM



“Using GIS as a tool to determine where clinics can be placed to maximize access to care is particularly relevant for primary care services associated with ongoing changes to our health-care system, especially in light of the Patient Protection and Affordable Care Act of 2010.”


Devon Taylor, Valerie Yeager, Claude Ouimet,  and Nir Menachemi. From article at;jsessionid=Z4XdvuJoks8vnPUBUzlL.38


The following are examples of mostly national but also some small area local applications of GIS to evaluate and display the health of a nation or region.  Most sets have 5 to 20 videos, with each video usually lasting 10-30 seconds.  [Warning: this material has taken hours/days (weeks) to download and is not yet fully edited.]


One of my early examples (an older website from years back, no longer active but still on line): Children in Offroad Vehicle Accidents -  There are about 25 others at this site as well.


The following are series of videos I compiled from my downloaded, open source teaching sets, of about 450, one 10-30 sec. video after another; each set is on on a different topics . . .


Social/public health issues:


My environmental health/occuaptional disease series:


Controversial examples:


Zoonotic diseases:


Foreign-born diseases (some overlap with priors):


Infectious diseases:


Homelessness (courtesy of a Pac NW project):


Childcare (incl. immunization):


NPHG projects:


Very early NPHG work:


In-migration Disease Patterns and Epidemiological Surveillance:


Just for fun:


Youtoons- getting ready for Obamacare --


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Prostate cancer: latest surgery practices

Prostate cancer: latest surgery practices | Global∑os® (GlobalEOS) |

Doctors are using revolutionary ice-ball surgery to kill prostate cancers.


Are the other smaller countries ahead of the U.S. sometimes!!??

Brian Altonens insight:

Recently, a classmate from my medical school years on Long Island during the early '80s told me about his clinic in the Carribean where he providedseveral unique services as a uro/UT-surgeon.   


My immediate response was to ask him something like 'what are you doing practicing in the Caribbean!?' . . . as if the health care system in the United States wasn't good enough. 


But the process he was about to engage in was fairly new, it was a new form of cryosurgery for my father-in-law designed to treat prostate cancer.   He was one of the first to perform this process in the United States (and since has gone on to bigger roles and positions within the U.S. teaching hospital system).


The process worked.  It was about a year or so ago that he performed it.  Like Dr. "Jay" said, there were minimal side effects and this process produced none of the problems associated with the other ways out there for treating prostate cancer.


When I asked Jay for more information about the processes he was  performing in the Caribbean, he told me about a few which weren't yet approved for use in this country.  He also told me that this was a major market for him, and that the numbers of people engaged in this treatment were phenomenal.


In the months that followed I updated myself about the status of health care practices in other countries.  


Back when he and I were classmates, none of us would ever dare go to a tropical school--the quality of education we felt was extremely limited.  But now, 30 years later, the possibility that someone underwent medical schooling in another country was more highly respected--all due to the web.


Likewise, these skills taught abroad can now be practiced abroad, including those still that are ahead of the time for the U.S. health care system.


For more on cancer treatment abroad by way of medical tourism (this is NOT a promotion, just to increase awareness about this competition):









PS.  This is very much a fledgeling field, so these info sources are superficial and perhaps biased.


***And be cautious of your search for "American University of the Caribbean" noted above--the web links realted to it are very much virus infested. 



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Rhinosporidiosis Rhinosporidiosis

Brian Altonens insight:

Everything about the following fictional ad is true, with the exception that at the corporate or business level, businesses are not performing at this high rate of productivity. 


This can all change, through the use of National Population Health Gridmapping, or NPHG – a technique applicable to any local, regional, national, or global healthcare program . . . .




Have a better understanding of corporate data through the use of the NPHG data mapping technique!


If your business does not interpret its progress, its failures and successes through daily data mapping, it is no longer leader in this competitive world. 


One of the main ingredients to developing a successful business is the daily use data mapping to better understand clients, cost and services.  The method presented here is not a traditional GIS.  It usually requires no up front products costs to be initiated.


The weekly to daily monitoring of products, consumers, cash flow, sales, people’s behaviors, health, and other internal measures is what NPHG was designed for.  NPHG has the potential of strengthening a company for which change can mean either going out of business or continuing to grow in the current business community.


To make the best of its corporate potential, a company needs to know its data inside-out.  This is what NPHG was designed for . . . answering any malingering questions that might exist spatially when making accurate corporate predictions or producing regional change.  


Overlooked data and metrics mean lost time, just as much as spending an hour going through only a few dozen or your regular tables or summaries provided before giving a presentation.  They never tell you everything you need to know about your business.  Three dimensional maps tell more on one page, than a 300 page report could ever inform corporate leaders about.


The only way to produce this information overload is through the use of NPHG.  You can use it to produce dozens of rotating map videos, more than 15,000 maps per day, five days per week, 8 hours per day, 50 to 52 weeks a year.  This equals about 3,750,000 maps per year. 


Now that’s productivity!


Of course, we rarely need to make videos to demonstrate our success, except on special presentations.  But that doesn’t mean we don’t have a need for this level of productivity in data visualization. 


You can still produce thousands of maps per day with NPHG, devoting these maps to specific metrics, at a rate of up to a million metrics per year, generating reports with hundreds of maps on specific topics, satisfying hundreds of clients per year if we wanted to. 


Knowing this potential is there for your company doesn’t hurt, and assures you the likelihood of staying ahead of your competition, so long as they are not employing their own NPHG.


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World Medical Tourism & Global Healthcare Congress » Wellness and Hospitality Industry

World Medical Tourism & Global Healthcare Congress » Wellness and Hospitality Industry | Global∑os® (GlobalEOS) |

"The World Medical Tourism & Global Healthcare Congress is a signature event of the Medical Tourism Association® 


"THE FIRST ANNUAL MEDICAL TOURISM RESEARCH SUMMIT brings together leaders from around the world to discuss emerging issues, share ideas and identify areas for collaboration. Building successful research models and working together to publish data is the goal of this initiative which will help organizations make better decisions and understand the industry better."

Brian Altonens insight:

This weekend's events are quite impressive for medical tourism!  


And competitors against the U.S. health care industry are well represented. 


The "Healthcare Reform Workshop" session/forum of this 9 Summit, 9 Forum program offers the following:


Learn what you need to know about the impact of Healthcare.


Reform on US employers and insurance companies at the:


“Healthcare Reform Opportunities for International Healthcare Providers Workshop” (Nov 3, 9am – 12 p.m.) during the 6th World Medical Tourism Congress (Las Vegas, Nov 3-6) and take that knowledge and network with over 1,000 of the leaders in the US health insurance industry, from employers, insurance companies to payors.




Seize on opportunity of healthcare reform:


1) Learn from insurance professionals who have successfully implemented medical tourism into self-funded and fully insured plans in the US. Learn how to include your destination in employer and insurance companies’ medical tourism plans.

2) Acquire skills to communicate more effectively with your target market. Employers and insurance companies need to comply with new regulations. Understand how the healthcare reform law effects them . . .

3) Understand the importance of Ethnic background to your employees and how to attract Ethnic employee populations to this market.  For example, according to the United States Department of Labor, by 2050, minorities are projected to rise from one in every four Americans to almost one in every two. By 2010, Hispanics are likely to become the largest minority group. Ethnic employees are more likely to travel to their home countries as cultural, language and other common barriers in medical tourism do not exist.

4) Learn how to design a successful marketing plan.  Learn how to get a strong handle on US employers and Insurance companies, hospitals will need to identify the different types of buyers and know who actually makes or influences the buying decision.

5) Enjoy One-on-one meetings with US buyers of healthcare. Participants will receive our concierge service to schedule one on one networking meetings at the congress.

6) Receive a Certificate of Completion. Showcase the healthcare reform skills and knowledge you gained at the workshop.

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