State by State Analysis of Health Insurance Exchange Adoption

State By State Analysis of Public Health Service Act Requirements for Employers in the United States

The Public Health Service Act of 2010 requires most employers in the United States to provide group medical insurance for their employees. Employers who choose not to comply with this law will be fined, as authorized in Section 490-H of the Internal Revenue Code. Employers with fifty or more employees are required to offer health insurance to their employees who work, on average, thirty or more hours a week. And the insurance plan must meet certain affordability standards, the employer must pay part of the cost and the plan has to meet certain eligibility requirements for enrollment equity. The global purpose of this act is to increase the proportion of people who have access to health care in the United States.  Evidence of the ability to pay for medical treatment through insurance thus contributes to this goal. The data source for the fifty-state-analysis, came from the National Conference of State Legislatures web site.[1] Also my book, Unraveling U.S. Health Care includes 50-state surveys for health care legislation as well.

Health Insurance Exchanges

Small employers are slated to enroll in regional insurance exchanges by 2014. Large employers may elect to enroll in the exchanges by 2017. The latter is the most intriguing, because initially it is thought that large employers will not choose the insurance exchanges. However, based on my experience as a former insurance broker here are some reasons why employers may ultimately choose insurance exchanges.

1.      1. The insurance exchanges will have federal compliance components built into the design and employers will not have to worry about being fined if they go through that process.

2.      2.  Employers can finance and have their employees enroll in insurance exchange health plans and avoid group health insurance administration hassles by having their employees make individual elections.

3.    3.    The insurance industry will see a shrinking of health care providers over time, especially in some states, so the insurance exchanges will become markets of choice.

4.      4.  Insurance exchanges are slated to include strict criteria for administrative transparency and target levels for allocation of insurance premium contributions to actually pay health care claims(AKA consumers like this)

5.      5.  Applying the law of large numbers, a large association of employers can expect some purchasing power and stability. In any case this is what the insurance industry has been saying for decades.

6.     6.   The insurance exchanges are designed not to discriminate and once again, consumers like that.

States Which Have Authorized Health Insurance Exchanges

Despite the tumultuous cries of calamity about the insurance exchanges, nearly half of the states have already adopted laws to implement them including: Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Nevada, Oregon, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

States Which Have Pending Legislation to Authorize Health Insurance Exchanges

Alaska is working to establish its own insurance exchange. The Georgia governor signed an executive order to authorize a Health Insurance Exchange. Mississippi has a state high risk pool for insurance and it is authorized to serve as a Health Insurance Exchange provider. North Dakota plans to create its own Health Insurance Exchange by 2013, otherwise the federal government will implement one. The Rhode Island governor signed an executive order to create a Health Insurance Exchange on September 19, 2011. The Texas Office of Insurance and the Office of Health & Human Services have partnered together to create its own Health Insurance Exchange. Vermont is working on creating its own state-wide single payer health plan. There are other states with pending legislation, but they were not cited because programs were not yet specified.

States Which Have Outlawed Health Insurance Exchanges

New Hampshire SB 148 became law on July 14, 2011 and it prohibits Health Insurance Exchanges.

It is important to note that a failure to authorize an insurance exchange is not the same as a ban and no other state had banned the exchange as of the end of 2011. Further, nearly all states have accepted money to implement the exchanges, some as much as fifty million dollars, so unless they are planning on giving the money back, they will also be creating their own exchanges.

Exceptions to the Rule

First of all, any employer who wishes to self insurance under the ERISA rules can exempt itself from all of these 2010 insurance plan design requirements. What this basically means is contracting with a third party administrator to pay claims and buying reinsurance through a broker.

Secondarily, the law seeks to provide financial subsidies for small employers who heretofore have had difficulty affording health insurance. This will mean more customers for the profitable insurance industry, which will now benefit by federal government subsidies for customers who are mandated to buy their product.

Thirdly, and perhaps most lucratively, employers who are enrolled or will enroll in “Professional Association Plans” or multiple employer trusts will be able to meet the requirements of the law.  These large employer plans are underwritten and managed by insurance brokerage firms. This is how the large brokerage firms deal with the small business sector; they fit them into their multiple employer association plans.

Though many insurance agents have been whining about the Public Health Services Act, the mandate for this act was promulgated by the insurance industry as a means to avoid obsolescence. Though the national insurance requirement will prove very lucrative for the industry, this does not necessarily mean it will benefit American health care purchasers to the same degree.

This article was written by Roberta E. Winter, MHA, MPA, the healthpolicymaven and may be reprinted with her permission.

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[1] http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx

How Medical Insurance Impacts Access to Health Care in the United States

Without Insurance Access to Health Care is Limited in the United States
Why the Insurance Model Was Chosen for Increasing Health Care Access
One of the things I learned while a student at the School of Public Health and Community Medicine was that people who lacked health insurance also lacked reliable health care. Let us review some of the national data in this regard. In my fifty-state analysis I reviewed the following components for individual health care measures: evidence of employer based health insurance, the state uninsured population, infant mortality and other clinical outcomes. Listed below are the top performers for the criteria, as well as the laggards.

States with the Highest Levels of Health Insurance, Public or Private
Using the latest Kaiser Family Foundation Insurance Survey , the 2010 results show the number one state for health insurance coverage is Massachusetts, with 95% reporting health insurance plans. Massachusetts has been the model for the national insurance exchanges because its state mandate has achieved near universal coverage and is self supporting. Other states deserving honorable mention for securing health insurance for 90% of their residents include: Hawaii, Vermont, and Wisconsin.

States with the Lowest Levels of Health Insurance, Public or Private
Women ages 19-64
In the same survey, the worst state for provision of medical insurance either public or private was Texas, with only 70% of its women reporting medical insurance coverage. The national average for insured women was 80% at the time of the survey. Florida reported that 74% of its adult women had medical coverage. A host of states reported only 75% of their adult female populations had medical insurance including: Arkansas, Mississippi, Nevada, and New Mexico.
Men ages 19-64
The national average for men with medical insurance was 76% by 2010. For Texas men only 65% had medical insurance. Other low fliers for men with medical insurance were: Georgia (71%), New Mexico (67%), and Florida (69%).
Children <18
Across the nation only 50% of our children had health insurance provided through their parent’s place of work. Though 90% of the nation’s children have medical insurance now, 36% of that figure is provided by public programs like Medicaid. For the children’s health survey, Texas also posted an equally poor level of insured children, the lowest in the nation, with 17% of the state’s children lacking medical insurance. This is despite the federally subsidized Children’s Health Insurance Program, so is Texas failing to enroll its children or are their parents making too much money to qualify?
Other states with high levels of an uninsured children included Florida (16%), Nevada (16%), and Arizona (15%). You would think Nevada could come up with something creative like a gambling tax to subsidize health insurance for its residents. Why do some of these states have so many more children without health insurance?
Cost of Deferred Health Care
Since the United States has chosen to finance its health care through a public and private system, the lack of payment for services for the uninsured gets allocated to hospitals and insurance plans. The federal insurance mandate is an attempt to stave the high costs for hospitals and communities from serving the uninsured population. Those states with higher levels of uninsured individuals mean that more health care is either delayed or delivered in emergency settings. Additionally, uninsured patients are not receiving preventive or basic health care. States that are laissez faire place a disproportionate burden on their hospitals to serve uninsured patients and this impacts the overall health care safety net.
Clinical Outcomes
If evidence of insurance is a factor in securing better health care, let’s see what the clinical data shows for these states. Infant mortality is an indication of prenatal and postnatal care and here are the infant deaths per 1,000 babies for the states with high levels of insurance, versus the low levels. These infant mortality rates are drawn from the 2009 Kaiser Foundation Survey. Infant mortality is just one measure of childhood health, but in adherence to brevity I am not going to list the other metrics I used in my full scorecard evaluation.
Infant Mortality
Best in class for both percentage of the population covered for insurance (95%) and the lowest infant mortality rate in the nation at 4.9 deaths is Massachusetts. Way to go mother Mass! This makes their prenatal and postnatal care equal to most of Europe, which is a high standard. And here is how the other well-insured states ranked for infant mortality per 1,000 babies: Hawaii-6.1 deaths, Vermont-5.6, and Wisconsin-6.3. Now let us compare this metric to the states which reported the lowest levels of children with health insurance and here are the infant deaths per 1,000: Texas-6.3, Florida- 7.2, Nevada-6.2, and Arizona-6.6. When you compare the average infant mortality of the states with higher insurance levels to those without, there is a difference of nearly one life per 1,000 babies, which is significant. Also, in case you don’t know, the United States infant mortality rate on average is 47th in the world, behind all of Europe and most of the developed world. And if you don’t already feel bad enough, some countries, including Singapore boast an infant mortality rate which is one third of the U.S. average at 2.31 deaths per 1,000 babies.

As we listen to the harping about Americans not having a right to basic health care, bear in mind that the United States has the highest percentage of children living in poverty in the industrialized world, at nearly one fourth (24%) of our child population. You have to ask yourself, what do our nation’s children have a right to in this wealthy country?

For more information on 50-state performance metrics come to the Northwest Women’s Show on March 2nd to hear excerpts from my book, Unraveling U.S. Health Care.

This article was written by Robert E. Winter, MHA, MPA and may be reprinted with her permission, but feel free to share it virally.

Congressional Wrangling Over Proposed Insurance Exchanges Takes A Nasty Turn

Wrangling Over Proposed Insurance Exchanges and Standard Health Care Benefits Takes a Nasty Turn

Barely recovering from the last congressional gaffe about redefining the rape of a woman in a transparent attempt to get out from under the federal Hyde Amendment criteria for Medicaid payments, the “powers-that-be” have made another mind blowing error in public engagement. In a nutshell and yes, I do mean all of these puns, here is the latest blunder by the Republicans controlling the house.

In a public hearing for testimony on the federal health insurance exchanges and standardized benefits for primary health care, which includes birth control options as benign as birth control pills, no women were allowed to testify at the hearing. It certainly is curious that those who are actually capable of pregnancy are excluded from the hearing. This refusal was despite vigorous opposition by female congresswomen. I actually listened to the hearing in order to believe it. And the woman they refused to allow to testify about the insurance exchange’s proposed standardized women’s health care was a college student. Yah, that is just what we want to discourage in this country, a woman with an education using prudence in reproductive matters.

And if that isn’t enough to befuddle a rational thinker, the reason the committee chairman gave for denying any woman the right to speak was because the meeting was about voting and safe guarding conscience in decision making. Interesting, I wasn’t aware that women lacked conscience, especially when you look at the violent crime statistics. But then again I guess these boys have turned their eyes away from those statistics. One wonders if they also were party to the move to redefine rape of an unconscious woman as a noncriminal event. If this is a matter of conscience, one wonders about theirs.

We are constantly assailed with Republican blather about fighting against big government, yet they seek to prevent birth control services from being covered on private insurance plans. As I have previously reported, several states already have enacted laws which prevent even private insurance plans from covering birth control services. Here are the members of this hall of shame: Kentucky, Missouri, Oklahoma, Idaho, and North Dakota. According to a 2003 Kaiser Foundation survey on contraceptive care, 87% of private employers provided coverage for birth control services, including abortion. So despite the anti-big-government talks, this smacks of big brother to me, or is it daddy?

For more straight talk on health care attend the Northwest Women’s Show on March 2nd, as the healthpolicymaven™ will present findings from her book, Unraveling U.S. Healthcare with my conscience intact.

Prediction Personal Investments 2012

KOMPAS.com - Many people hope offered by Indonesia in 2012. One is the improvement of Indonesia's economy in the next year. "In a meeting with Commission XI some time ago, the government gave a positive signal about economic growth in Indonesia due to an increased demand for domestic products," said an expert financial planner Aidil Akbar Madjid, MBA in outlook 2012 AFC exposure Financial Check Up.

Although Indonesia's economy is predicted to slowly strengthen, but it seems in terms of personal investment you need to remain cautious. Akbar following the advice given to private investment in 2012:

1. Investment in property. If banks continue its commitment to lower interest rates including the interest rate mortgage loan, it can be said that the investment property has a great opportunity and good in 2012. In fact, this property is estimated that the business will go up even higher. "But be careful with the price is high enough," he wrote. In big cities like Jakarta, apartments at a price below USD 800 million, Flats Property or Rusunami (subsidized apartments) can be used as an alternative to long-term investments are profitable.

2. Investment precious metals is not very profitable. If the conditions of the Middle East heats up, then world oil prices will rise in line with rising world gold prices. But this will not be too influential on the price of precious metals because of the exchange rate of dollar to rupiah weakened. If this condition is reversed course in which the dollar strengthened and the crisis in the Middle East and re-heated, then this precious metal investment will be excellent. Precious metals can be selected, among others, in the form of jewelry such as necklaces, bracelets, earrings or gold bullion.

3. Equity investments. If you are interested to invest in a variety of things a bit challenging, it would not hurt to invest in stocks. If the investment grade increased, the flow of foreign funds will go even more and one of them entered the stock exchange. This will push the stock exchange to crawl up and through high level as in early 2011 and then, obviously Akbar.

With a controlled inflation and low interest rates, bonds will be much coveted by financial institutions and companies. SUN, ORI, Retail Sukuk Sukuk and can also be considered for an investment option other than Fixed Income Mutual Funds. "Stocks still gives a pretty good potential in 2012," he explained.

4. Investment securities. With the limitation of the number of credit cards and loans, banks have access to funds that have not been channeled. If funds can not be used for consumer loans, mortgages, and credit vehicles can be diverted to the possibility of such securities Debt securities and Setifikat State Bank Indonesia (SBI).

5. Short-term investments. For short-term investments should still use banking products and precious metals. Its primary focus is to raise funds and hold before the Composite Stock Price Index (CSPI) moved up. After JCI rising, you should invest in the stock market.

Note Akbar others are wary about investing in some type of insurance or unit-linked investments that will mature in 2012 (10 years from its launch in 2002). "If it turns out unsatisfactory investment returns, after deductions and other expenses, can lead to disappointment and even complain. So you should be careful with your insurance choice," he advised.

Stopping the Over Charging in the U.S. Health Care System

How Profit-taking Distorts Health Care Delivery in America
Recently, a Public Broadcasting Station (Channel 9) featured a story on a for-profit hospital group which was using obscure diagnostic codes to achieve higher Medicare payments. The level of unethical and fraudulent activity was so egregious that more than one of their billing coders quit their jobs and testified against their former employer. The Wall Street Journal has also reported on fraudulent Medicare billing, including requisitioning public records from CMS(Medicare) and identifying abusive billing practices by multiple clinicians. For example, the New York City osteopath who billed Medicare 2 million for family medicine, when this was not the nature of her medical practice. WSJ staffers examined the Medicare database and uncovered 25 billing codes for an array of expensive medical tests which were regularly performed by 20 other clinicians in the country. Of that group, 33% have already been convicted of fraud, have undergone professional ethics investigations, or worked in the same firm as the convicted physicians. It is safe to say that this high correlation of billing blips is no accident. Unfortunately, because the American Medical Association prohibits the government from disclosing clinician compensation, even if billing practices are fraudulent, those physicians are not publicly named. Basically, this means a lot of people are still getting away with fraud. This article reviews how profit-taking motives distort the U.S. health care system and does not contribute to health care improvement.

First of all, it is legal to deliver health care services and make a profit in the United States, but it is not legal to defraud the government or private sector insurance companies by making false claims to incur higher reimbursements. In plain language, this is known as stealing and this article will show how the incentives to steal are so high in the current U.S. health care system that despite penalties, including jail sentences, the phenomena continues to rob money from all U.S. health care payers. The payers are the individuals who must obtain health care services at inflated prices to subsidize excessive profiteering and fraudulent activities in many sectors of the national health care milieu.

By focusing on changing the alignment of reimbursements for many health care providers from a volume-based principle to outcome-linked measures we will be able to identify the outliers in the shell game of medical monopoly. Several aspects of the 2010 health care reforms seek to address the abuses of health care reimbursement in the country, including more stringent requirements for health insurance company financial reporting of premium payment utilization. Additionally, there are financial incentives for clinicians who achieve better outcomes for targeted medical conditions under the Shared Savings Rules. And finally, the systemic review of medical supplier over-charging is also included in the reform provisions.

Accountable Care & Incentives for Health Care Outcomes
Accountable Care rules for hospitals and integrated health care organizations include Shared Savings methodology or a bonus if you will, for those medical groups which produce desirable clinical outcomes. This realignment in Medicare & Medicaid reimbursements will ultimately save U.S. taxpayers money for federally funded health care programs. In other words this changes the equation from paying for volume to actually paying for clinical performance, and the best performers will receive more money than those who have poorer clinical quality. For example, if your facility has more hospital re-admissions for a specific procedure than the evidence shows is desirable, that will impact your reimbursement. This is a good thing for the country, although I am sure some health care providers are concerned about the ramifications for their practices. Clinics and hospitals are not required to become designated as Accountable Care Organizations at this time, but the pay-for-performance methodology will ultimately be spread throughout the country as organizations respond to this trend.

Creating Efficiencies System-wide
As previously reported in 2010, the establishment of the Comparative Research Institute seeks to review system-wide data on medical equipment suppliers and clinician practices, in order to optimize value for U.S. taxpayers who fund federal health care programs like Medicare. Though this has been criticized as just another government agency, the purpose is to look across the health care system of disparate providers including; medical equipment suppliers, purveyors of high-tech devices, and clinics to find ways to save money for the entire system. Certainly not everyone will be happy with this process, but one wonders how many of them are in fact the excessive profiteers.

Like it or not, several components of the 2010 landmark health care legislation are here to stay because they profoundly impact Medicare and Medicaid programs, which consumes 32% of the 2011 federal budget. We do need to spend taxpayer money more wisely and part of that process includes scrutinizing all of the components of health care delivery. The government oversight is necessary to curtail cheating and other criminal activities.

A Clinical Case: How America’s Private Health Care System Is Not Producing Best Practice Results for Kidney Dialysis
A basic tenant of a capitalist economic system creates a disproportionate incentive towards money making activities which often fall short of optimal patient care. A good example of this capitalist infusion is the kidney dialysis system in the United States, which sprang up because of the congressional ruling to cover end-stage-renal-disease under the Medicare umbrella in the 1960’s. The entities that seized this “new market” were largely for-profit corporations. For those of you who do not know, kidney dialysis is a mechanical cleansing process which is lifesaving for those whose kidneys have ceased to support their renal systems. International data on dialysis treatment shows that Americans on dialysis do not survive as long as patients in other industrialized countries and also experience more clinical complications. This should come as no surprise when the corresponding American health care incentives are based only on providing the dialysis procedure, not optimizing patient health.
For the profitable dialysis centers, like DaVita, business has been brisk as the American population undergoing dialysis has grown from 11,000 people at inception to over 300,000 people today. Each patient on dialysis brings in about $72,000 just for that procedure, so the industry is worth billions. Examples of how the maximization of profit has impaired clinical processes include the dialysis center protocols which discourage the use of fresh kidney processing devices for each patient and thereby greatly increase the chance of infection. So some MBA figured out they could save their organization money by reusing artificial kidneys on a critically ill population and this has become a standard of practice.
Another example of a U.S. renal failure outcome which differs from other global practices is the limited number of dialysis patients who use the peritoneal process, which can improve the individual’s the quality of life. Clinicians have suggested that American patients are often too ill to be eligible for the home-based peritoneal process. As a society which is paying for this treatment, we need to be asking what we can do to treat these people earlier in their disease progress, so they may become eligible for less taxing treatments(and less expensive). Too often the U.S. health care system steps in literally at the “end-stage-of-treatment” because our system of economic reinforcements only assures payment at that time. This dichotomy is what needs to change.

Evidence-based planning which I have previously written about (and continues to be one of the most popular articles for this readership) is all about reviewing appropriate scientific data to discern the optimal blend of clinical intervention and patient outcomes to benefit a population. This process is what we need to be doing as a nation in order to optimize health care services for the entire population.

Election Implications
Since 2012 is an election year, when you start to hear the rhetoric of “getting the government off our backs” remember that doesn’t mean you will pay less for your health care premiums or services. In our blended system of public and private health care services, we must have an external audit and enforcement arm and the government does this for us all. Like it or not, our government does perform essential services which benefit the average American. The 2012 election mantra should be focused on creating government oversight linked to performance outcomes, not merely less government.

Basic Economics
Anyone who has taken basic economics coursework knows that government intervention occurs when there is a failure-to-perform in the private sector. Certainly, the executives at Premera Blue Cross understand this principle, which also explains that entity’s rush to embraces some changes in their health insurance model. The old insurance company model was a paternalistic one where insurers dictated what they would cover, but the new model requires further explanation and reporting of clinical results, because of government requirements. Reporting results is a good thing for the health care consumer and the edict to explain them in an understandable transparent manner is a victory for health care consumers. This transparency also includes the disclosure of the commissions your insurance agent makes and there is nothing to be ashamed of there, if your agent or broker is working on your behalf and is not over charging (group insurance commissions are negotiated for experience-rated groups). In the truest sense of an open market, price information is available to the consumer who is then empowered to choose an agent or service provider for both the price and the value. Hopefully the disclosure will extend to voluntary health and accident programs as well, as some of the greatest abuses of value occur in that area.

The healthpolicymaven will be speaking at the Northwest Women’s Show March 2nd, 3rd, and 4th on the U.S. Health Care System and How to Optimize Your Health Care Outcomes in the Face of Reforms.

This article was written by Roberta E. Winter, MHA, MPA and may be reprinted with her permission.

5 Ways to Happier Life

KOMPAS.com - A year passed, the range of achievements you may have already achieved. However, whether the various success was followed by a reassuring feeling of happiness? If happiness be the one thing that you are still trying to make happen, started the new year, prepare yourself with a number of ways to achieve complete happiness.

Michele Woodward, a career planning specialist and author of I Am Not Superwoman: Further Essays on Happier Living, saying, "You can feel happy to have time to make friends, and connect with people around you, which can enrich, give meaning and valuable experience other. "

Here are five ways that suggested Woordward for your happiness began to run in the new year:

1. Give credit for your accomplishments during the year 2011. Sit down, and grab a pen and paper, then make a list of your top 25 achievements that you managed to accomplish during the year 2011. "Maybe this will surprise yourself because, without realizing it, you have successfully achieved many achievements during this year," said Woodward.

This method is important to do as a form of appreciation on yourself and improve self-confidence. With more respect yourself, you helped to have the mindset that you're capable of doing many other great things, next year.

2. Determine a realistic goal. You will feel the happiness when it succeeded in meeting the target of the goals that had been developed previously. The economist Angus Deaton, PhD, and psychologist Daniel Kahneman, PhD, reveals that the happiest people are those who set realistic goals for themselves. The goal is more likely to be achieved.

In line with this, Woodward said that setting realistic goals this does not mean you give up on your big dreams. However, finding out what you want and to be achieved, then the focus to find ways to achieve it.

3. Find fun activities outside of work. "Do variety of activities that are meaningful and useful as well as fun for you," said Woodward. Various activities such as volunteer activities, starting a personal creative project, or develop your social relationships in various communities.

4. Responsible for the condition of your life. Woordward said that while working, goal to achieve financial comfort is still needed. However, responsibility for ourselves not just measured by the amount of money that you can get. Form of responsibility for yourself also means you can change various things that you do not like, in order to live a more enjoyable.

"If you have a terrible life's journey and weight, then consider turning it into a more convenient way to give meaning in your life. One way or another, looking for a new job or moving to a new place better," added Woodward.

5. Surrounded by people you care about. When surrounded by the people closest to you, such as family, friends, spouse or lover usually you will feel the excitement. This is because it turns out, being around the people you care about bringing positive energy for yourself.

Ready to be happier in the new year?

6 Food Support Job Interview

KOMPAS.com - Stress, nervousness, stomach pain, psychosomatic complaints like this are often attack at the crucial moment, including during a job interview. Although already practicing to answer questions, but if the nervous attack, everything on the head can be blank instantly.

Instead of answering questions candidly, you just respond to questions with the words of obscure meaning, or even forget to say anything. When this happens, chances are you stricken from potential candidates.

One way to avoid it, you can eat certain foods that make you feel more calm, focused, and able to think fast. Eat these foods at least one half hour before the interview, so most food is digested and have a positive effect on the brain.

1. Whole grains and green vegetables.
B vitamins, like vitamin B6, B12, and folic acid is proven to help memory, focus resources, and health and ability of the brain as a whole. In fact, folic acid can help produce red blood cells and improve the well-being and mental clarity.

Whole grains like brown rice, a major source of vitamin B. Meanwhile, green vegetables such as spinach, kale, and Swiss chard contain high folic acid and vitamin K, which will also help the brain to focus and fight memory impairment.

According to Beth Reardon, nutrition experts of Duke Integrative Medicine, Durham, South Carolina, three bowls of spinach could supply 40 percent of the magnesium. It is a mineral that can reduce the effects of stress in the body by preventing high blood pressure soaring.As a variation makanana, you can also put the spinach into the omlet or a sandwich.

2. Fat-free protein.
It is better to avoid carbs before a job interview because it can cause drowsiness. A study of two groups, ate breakfast of protein and high carbohydrate breakfast, it was found that two hours after eating, the group that ate a high carbohydrate had tryptophan levels four times higher than the group who ate the protein. Tryptophan is a substance known as a trigger sleepiness.

Meanwhile, protein helps the body produces two chemicals made from tyrosine, norepinephrine and dopamine. This substance will increase mental alertness. Fat-free protein you can get from white meat and eggs.

3. Healthy fats.
The brain requires a supply of healthy essential fatty acids or omega-3 fatty acids in order to function optimally. Fat is a major building block of brain tissue. It will even help you stay focused, protecting brain cell membranes, and reduce disease dementia, Alzheimer's, stroke and other brain diseases later in life.

These fatty acids can only be obtained from food. Therefore, the human body can not produce it naturally. You can get it from fish, walnuts, olive oil, avocados, and flaxseed.

Hemp seed is also the best source alfalinoleat acid, a type of healthy fat that increases the performance of the brain cortex, where the brain processes sensory information. As for fish, especially salmon contain omega-3 can enhance the ability of the brain and reduce senility. The study, published by the Diabetes & Metabolism, shows through cognitive tests, participants who ate salmon during three weeks of anti-stress hormone known to spend a higher level.

4. Orange
Eat an orange for stamina awake during the interview. According to a study conducted by researchers from Carnegie Mellon University in Pittsburgh, healthy people who are stressed can be a pain.

Basically, blood pressure greatly affects the immune system. However, it can be combated with regular consumption of vitamin C that is widely available in orange. Vitamin C will increase the body's immune cells and reduce the risk of viral entry.

5. Chocolates.
During this chocolate is known as a stress reliever food. According to Alan Hirsch, MD, director of the Smell & Taste Treatment and Research Foundation, Chicago, chocolate will increase the level of the neurotransmitter substances into the brain. Increased spending on these substances will trigger hormone maker happy and relaxed, like hormone dopamine.

6. Coffee
As long as your body is no problem with the coffee, you are advised to consume these drinks before facing a job interview. According to the researchers, coffee can increase short-term memory performance and help increase the capacity of attention and problem solving skills.

But, it is better not to overdo when drinking coffee. Too much coffee not only will make you urinate frequently, but also will make you jittery and nervous. As a result, you can look unprepared in front of the interviewer.