Healthcare Rationing

1. Healthcare Rationing PH350 Medical Ethics Fall 2011 Presented by: Jennifer Johnson, Vivian Jones, Elizabeth Lewis, Victoria Howe, & Jennifer Hutt Click Here for Voice Thread Presentation

2. Topics To Address • Definition • Nurse and Doctor’s Role • Current Strategies for Rationing • Examples • How HC Rationing is Managed • Is it Ethical • Pros • Importance • Cons • What happens when there is no rationing • Conclusion

3. Rationing is the limitation and allocation of certain products or services. • Healthcare rationing is defined as the limitation of access to or the equitable distribution of medical services, through various gatekeeper controls. • HC Rationing takesplace when a treatment is denied by health care provider or insurance company. • Decision-making by healthcare workers is based on: • who needs the resource most • which treatment has the maximum benefit or outcome to society/population • which is cost effective

4. Nurse and Doctor’s Role ANA Code of Ethics- Provision 1 “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” AMA Code of Medical Ethics Opinion 2.03 -Allocation of Limited Medical Resources “A physician has a duty to do all that he or she can for the benefit of the individual patient. Policies for allocating limited resources have the potential to limit the ability of physicians to fulfill this obligation to patients. Physicians have a responsibility to participate and to contribute their professional expertise in order to safeguard the interests of patients in decisions made at the societal level regarding the allocation or rationing of health resources. Decisions regarding the allocation of limited medical resources among patients should consider only ethically appropriate criteria relating to medical need.”

5. Current Strategies to Ration Resources • Public Policy • Organizational Level • Clinical Level

6. Examples of Rationing • Going to a doctor for treatment and paying for prescriptions • Going to the drug store and getting over the counter remedies. • Limiting the doctors you may visit because fees are negotiated with specific doctors. • Charging co-paysand deductibles.

7. How is Healthcare Rationing Managed? • Private Insurance Companies • Medicaid • Medicare

8. Private Insurance Companies • For-profit industry • Co-pays • Deductibles

9. Medicaid/Medicare • 2011- 60 million Americans • 2014- 76 million Americans • State income is averaged • The federal government matches based on an estimated national average. • This means lower income states that need more subsidizing for Medicaid & Medicaid actually receive less money than states with a higher median income

10. Is It Ethical? Three Basic Ethical Precepts: • Individual Autonomy • Beneficence • Distributive Justice

11. Is It Ethical ? • Limit to the available health care resources • Health care will have to be allocated to those who need or want it. • Everyone cannot get all they need or want.

12. The Pros to Healthcare Rationing “You can treat some of the people all of the time or all of the people some of the time, but you cannot treat all of the people all of the time.” • Healthcare resources are limited.

13. Importance of Rationing • About 43 million Americans are uninsured. This leads to low quality care and negative health in the uninsured. • The U.S. is the only industrialized country that cannot guarantee access to healthcare for all its citizens. • The U.S. healthcare system is the most expensive in the world, however limits more people to its access than any other industrialized country in the world. • HC costs will continue to rise • Technology advances • Aging Population • Conception that HC is a market good

15. The Cons to Healthcare Rationing • No predetermined plan that addresses how resources should be allocated. Without such a plan providers are becoming “gatekeepers.” It is an act of balancing the limited resources depended on morbidity and finances. • Without a predetermined plan the providers find themselves in a position having to make decisions to award or deny services.

16. If Healthcare Rationing Did Not Exist . . . • Government-mandated procedures will likely reduce doctor flexibility and lead poor quality patient care.  • Less incentive to pursue medical-related research, development, and investment. • Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession. • Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, and have more complicated health care problems 

17. If Healthcare Rationing Did • Not Exist . . . • Patients may be subjected to extremely long waits for treatment. • Health care services may end up being rationed by the government. • Increased government taxing and restrictions will lead to loss of personal freedoms. 

18. Conclusion • Due to the combination of increase healthcare costs and the number of uninsured it is evident that healthcare rationing must be implemented. • It is seemingly impossible to rid healthcare allocation for the reason that the number of uninsured and the cost of healthcare will only continue to grow. • In today’s goal for healthcare is to provide affordable healthcare for all, however no objectives are in place to meet this goal. • Everyone deserves to be treated equally, however resources are not unlimited. • The U.S. cannot afford healthcare unless limitations are placed on it. HC rationing must continue. Now Click Here to Quiz your Knowledge!

19. References • 1) American Medical Association. (2011). AMA Code of Medical Ethics: Opinion 2.03- Allocation • of Limited Medical Resources. Retrieved December 11, 2011. http://www.ama • assn.org/ama/pub/physician-resources/medical-ethics/code-medical • ethics/opinion203.page (This website addresses the medical profession’s ethical stance on the allocation of limited medical resource). • 2) The American Nurses Association. (2001). Code of Ethics With Interpretive Statements: • Provision One. Retrieved December 11. 2011. • http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur • es/Code-of-Ethics.pdf (In the ANA Code of Ethics the reader understands the ethical stance of the professional nurse). • 3) Andre, Claire. (2010). Aged-based healthcare rationing. Santa ClaraUniversity.http://www.scu.edu/ethics/publications/iie/v3n3/age.html ( This article discusses America's aging society and how healthcare rationing effects the elderly and also the rest of the population). • 4) Barr,D.A. 2002. “Where Do We Go From Here?” In Introduction to U.S. Health Policy: The • Organization, Financing, and Delivery of Healthcare in America, 223-37. San Farncisco: • Benjamin Cummings. (Interesting quote related to healthcare rationing). • 5) Brook, D. W., Rationing: Health Care Cost Monitor: Why It Is Ethical. The Hasting Center (2009) • Retrieved November 20, 2011 from http://healthcarecostmonitor.thehastingscenter.org/danbrock/why-it-is-ethical/#ixzz1gvJCYOdA (This article discusses why healthcare rationing is important and inevitable).

20. References • 6) Cookson, R., & Dolan, P.: Principles of justice in health care rationing, J. Med. Ethics. 2000;26;323-329 • doi:10.1136/jme.26.5.323 (This reference discusses in the principle of justice and it applied by healthcare professionals or clinicians everyday rationing decisions). • 7) Callahan, D., “Rationing: Theory, Politics, and Passions,” Hastings Center Report 41, no. 2 • (2011): 23-27. Campbell, D. (2011, 8 9). Column: Ration health care with Medicare • credits . Retrieved 12 9, 2011, from USA TODAY: http://www.usatoday.com/news/opinion/forum/2011-08 • 09-medicare-healthcarereform-ration_n.htm (This article discusses how our society would function with and without Medicare). • 8) Canadian Medical Association: Can rationing possibly be rational? Canadian Medical Association Journal, August 9, • 2011, 183(11) (This article discusses a parent who was not happy about the rationing decisions by healthcare professionals when treating her child, questioning the rationality of “healthcare rationing). • 9) Crowe, Mary Lind. Allocation of Healthcare Resources at the Point of Care: An Ethical Dilemma • for Healthcare Providers. (2010). The Journal of Legal Medicine.31, p455–465. (This journal article introduces the ethical dilemma for healthcare providers in regards to allocating healthcare resources. It discusses the current strategies used for rationing resources.) • 10) Eboch, J. (2010, 1 4). Health Care Rationing in Virginia: A “Success” Story . Retrieved 12 9, 2011, from Tenth • Amendment Center: http://virginia.tenthamendmentcenter.com/2010/01/health-care-rationing-in-virginia-a • success-story/ (An example of the failed healthcare rationing in a specific case in Virginia). • 11) Floyd, Elizabeth J. (2003). Healthcare Reform Through Rationing. Journal of Healthcare • Management. 48:4, p.234. (This journal discusses the need and importance of healthcare rationing in the U.S.)

21. References 12) Gaudine, A., LeFort, S. M., Lamb, M., Thorne, L.: Clinical ethical conflicts of nurses and physicians. Nursing Ethics (2011): 18(1) (This article elaborates on the ethical conflicts and dilemmas in healthcare professionals when faced with making healthcare rationing decisions. It also addresses the code of ethics of autonomy, beneficence, and justice). 13) Healthcare Rationing is Good. (2009). The Baseline Scenerio: Word Press. Retrieved December 11, 2011. http://baselinescenario.com/2009/09/02/healthcare-rationing-is good/ (This article provides the reader with the current healthcare debate over cost inflation, healthcare infrastructure, and proposals for providing quality care). Medicaid and Chip Provide Health Coverage to Nearly Sixty Million Americans. (2011). Retrieved on December 02, 2011. http://www.medicaid.gov/index.html (This source has figures along with various other information about Medicaid how it works, and various information about the program, benefits, and information to determine qualification about its programs). 15) Messerli, J. (2011, 11 16). Should the Government Provide Free Universal Health Care for All Americans? Retrieved on December 9, 2011, from BalancedPolitics.org: http://www.balancedpolitics.org/universal_health_care.htm (Information on the pros and the cons of providing free health care for Americans). 16) Povar, G., Blumen, H., Daniel, J., Daub, S., Evans, L., Holm, R., & ... Campbell, A. 2004). Ethics in practice: managed Care and the changing health care environment: medicine as a profession managed care ethics working group statement. Annals Of Internal Medicine, 141(2), 131-136. (Discusses ethical rational used to ration health care services by medical professionals, patients, and health care organizations).

22. References 17) Romeo, J. (2010). Contemporary topics in health care. Rationing. What is the future of health care rationing? PT In Motion, 2(1), 26-31. (This article is about current healthcare rationing issues and possible future solutions that are being looked into). 18) Russell, B. (2002). Health-care rationing: critical features, ordinary language, and meaning. Journal Of Law, Medicine & Ethics, 30(1), 82-87. Singer, P. (2009, July 15). Why We Must Ration Health Care. Retrieved on December 9, 2011, from NYTimes: http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=2&pagewanted=1 (This article explores healthcare rationing and important characteristics of the system in America.) 19) Singer, Peter. (2009). Why we must ration healthcare. The New York Times. MM38.               http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=all. (This is an opinion article written in a newspaper about healthcare rationing and how services are distributed within this system. It also discusses how healthcare is financed and people's perceptions of healthcare rationing). 20) Tennant , M. (2011). The New American. Retrieved on November 28, 2011. http://thenewamerican.com/usnews/health-care/9509-states-rationing-healthcare-under-medicaid (The New American discusses Medicaid rationing techniques used among different states). 21) Torrey, T. (2008). About.com. Retrieved on December 01, 2011. http://patients.about.com/od/patientempowermentissues/a/rationing.htm (Defines and gives examples of different types of rationing. The article goes on to describe and give examples of rationing by self, government, and private insurance companies). 22) Villarreal, P. (2006, July 31). Federal Medicaid Funding Reform. Retrieved on December 02, 2011. http://www.ncpa.org/pdfs/ba566.pdf (Describes how the budget is determined for Medicaid and Medicare funding in the United States).