Financing Health Care

Financing Health Care

Financing Health Care

Professional Development Assignments: (60 points)
1. Managed care organizations emphasize physicians’ responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed “gatekeeping.” Some argue that “gatekeeping” is unethical because it introduces financial factors into treatment decisions.

Others say it improves quality by promoting the use of the most appropriate levels of care. Take a position on this issue and explain your view.

2. If we accept the premises that resources available to meet the costs of health care are finite and that continuing to increase dollars allocated for health care expenses carries “opportunity costs” for the nation and society, discuss your position on the following: As a national policy should we allocate a set level of resources and apply them to achieving “the greatest good for the greatest number” (necessarily leaving some out) OR should we adopt the individualist approach of “those who can pay to get, those who can’t, don’t”?

3. Medicaid is shouldering an ever-increasing burden of cost for long-term care for the elderly, with enormous impacts on state budgets throughout the nation. Discuss alternatives to ease this drain on Medicaid resources.

Each response should be 500-1000 words
APA formatting required


Financing Health Care

Case 1
Assuming the position of an opposing side to the practice of “gate-keeping” or rather managed care organizations, one would refute the idea that this particular exercise is meant to provide access to quality and appropriate care. The fact that the organizations exhibiting this practice are often aimed at controlling the access of specialty care and expensive hospitalization, this condition induces financial factors and profit-making goals in the health care provision processes.

The idea of providing care to patients while using service prices or charges to determine what type of treatment to administer to a given patient proves the health care system to have profit as the priority and core business activity. Health care professionals and organizations are always guided by the oath of protecting the health of the people at all costs.

This means patient safety comes first and issues of determining the charges or fees are to be dealt with later. Gate-keeping practices would definitely kill the health care ethics on service first and payment later since the main goal of the hospitals would be evaluating he needs of the patient population in relation to the specialty care costs.

Presuming that nurses and doctors of any medical facility are primarily guided by this managed care goals, this would force them to serve only those patients who require more of special care and expensive hospitalization services for this would in turn gain the management some increased returns. Also, the provision of quality care would be shifted from ordinary or normal health care services to the specialty care.

The issue of physicians controlling patients’ access to specialty care and expensive hospitalization should not be advocated for since induces some discriminatory feeling in the care provision. For example, if a certain patient requires heart surgery and they are poor, the nurses and doctors would not allow them to undergo the surgical procedure since it is their duty to control the access of such expensive health care services.

They would review the case and dismiss it since the featured patient is not capable of taking care of the expenses associated with such care. Thus, this particular patient might die just because they nurses were determined to control the access of special care and expensive hospitalization. Therefore, one would depict some traces of healthcare service delivery discrimination for this managed care practices induce some social economic status differentials in the care provision setting.

Only the rich would be able to enjoy the special care and expensive hospitalization. In real life health situations, a patient is not supposed to be discriminated by his or her social economic status since the health care services are universal or rather made for all. Thus, one would present an argument that “gate-keeping” practice promotes variations in the care provision context, especially when it comes to matters of social economic statuses.

The resultant thing of this type of practice in the health care setting would be providing poor quality of care to the poor patients and specialized care to the financially capable patient populations. The assertion provided in the case that managed care practices allow individuals to promote quality through the use of appropriate care levels is absolutely flawed.

This is because this culture presented by health care professionals would only be aimed at making profits for the various healthcare organizations at the expense of the patients’ lives. Hence, the gate-keeping practice can be said to promote healthcare class differentials and discrimination.

Case 2
Health is life and everybody or at least majorities deserve to get quality, reliable, and affordable health care. National policies on health should always be designed in a way that includes majority of the global populations in their planning, organizing and dispensation of public health care. Health is a currently considered a basic need since individuals cannot survive or live long without proper care.

It is not like education which people can comfortably live without and still pose an improved economic structure. Both the poor and rich require health care services irrespective of their social economic statuses. Therefore, an integration of the two statements provided for this discussion, one would definitely choose to side with the assertion that “national policies should allocate a set level of resources and apply them to achieving the greatest good for the greatest number.”

The perspective upon which the aforementioned argument is established on is the utilitarianism. In utilitarianism school of thought, the main idea under emphasis is always about acting in a way that maximizes the outcomes and causes little or no harm to the greatest number of people. Personally, health care is a career field that requires professionals who are ‘big-hearted.’

Individual practitioners are expected to act in a manner that poses the greatest advantage to majority of the patient population (Husted & Husted, 2008). In addition to this professionalism culture, health policies and nursing regulations compel the medical experts to work and live up to such standards where every decision made has to be inclusive of aspects of doing the greater good for the majorities.

On the other hand, the second statement which represents the cons of this discussion, it asserts that national health policies should be designed in a way that promotes health care services for those who can afford them only. This individualistic approach is reflective of the actual or real life situation in health care, but this does not mean people should support it. Of course, the rich people can be said to get the best care while the poor strain with low quality care services.

However, this situation might be real but it does not indicate that national health policies are inclined to support the individualistic approach on matters concerned with public health. The basic goal of national policies is to ensure that every person has equal and quality access of health care services irrespective of the geographical location they are situated.

Therefore, it would be recommendable that the national health policies be redirected to allocating a level of resources in order to deploy them towards achieving the greater goo for the majorities. If at all a health policy planners were provided with various alternative about the goals of these policies, they would exercise opportunity cost by foregoing all other choices and deciding to stick to the utilitarianism approach when design the policies.

The other alternatives might be of benefit to the health care institutions, but the most ethical and rationale approach would be designing health policies that encompass the inclusion of all in the provision of care. The approach might not be 100% inclusive of every individual, but at least majority get to benefit from it.

Case 3
As the working history of Medicaid reveals, this health care organization has been operational for quite some time back in the United States and its core business activity is to provide health coverage to the less fortunate or the vulnerable societies (Miller, 2014). For example, the agency provides health care to the poor, disabled, the elderly, pregnant women and children.

However, due to its working strategy which is founded on low-cost or free health coverage, this organization has been facing a lot of financial constraint along the processes of providing the care to these targeted populations, more so in the long-runs. The focus here is the cost burdens incurred while providing care for the elderly in the long-term phase. Below are some of the solutions that this health agency could implement in order to substantially reduce the costs.

Imposition of Service Fee on Clients
The fact that this agency strategizes on health coverage for free so that it may help the less fortunate people; this is the reason behind its cost burdens. The number of this target population keeps on increasing day by day while the allocated resources within the national budget remains fixed or even depreciates. Therefore, this means that the capital or rather the resources redirected on helping these populations would be scarce under competition since the number of beneficiaries is ever going up.

However, if this medical agency decides to impose a universal health service fee to all its clients regardless of what type of care they might be interested in, this strategy would help the organization raise enough capital to combine with the existing one in order to ensure no uncertainties are faced on the long-term health provision practices.

Partnership with Other Health Agencies
In business, forming partnerships ensures that a risks associated with a single business entity are shared between the joining partners. The same technique would be effective for Medicaid since this move will shift or at least lower the level of health costs associated with long-term care for the elderly to the joining partner.

The costs which were incurred by a single business, Medicaid, they would now be either shared between the two or lowered to manageable levels since the joining agency would contribute some financial input to the course. Hence, one would say that partnership would be an apt strategy for Medicaid to offset the health care cost burdens presented by the long-term care for the old people.

Imposing Limits on Care Period
Medicaid has always ensured that it takes care of the elderly for the rest of their lives or until a client dies. This kind of commitment is what has also contributed to the increased health costs. The best solution to this practice would be setting a limit on the care provision period such that an individual will only be taken care of until they regain independence on their health and then released.

Thus, this strategy would ensure that the costs that come along with health complications which the elderly present with time are completely avoided. It is obvious that the old would always present preceding complications throughout their lives and they come with an increased health cost. Therefore, it would be better if Medicaid took care of them for a finite timing and then dismisses them on gaining health independence. Hence, the costs which were incurred due to long-term care would be fully avoided.

Husted, J. & Husted, G. (2008). Ethical decision making in nursing and health care : the symphonological approach. New York: Springer Pub. Co.
Miller, E. (2014). Block granting Medicaid : a model for 21st century health reform. New York, NY: Routledge.

Also check:  Concept Synthesis Paper on Personal Nursing Philosophy