Obamacare was aimed at improving the quality, accessibility, and affordability of healthcare to every American citizen. However, the healthcare costs, payment complications, the multiple payment systems, and modes of access have increased confusion for patients due to the increment of entities the patient interacts with when seeking healthcare. These complications have resulted in a decline in public trust in the healthcare system, providers, and insurers. According to Khullar (2018), recent studies depict that only 34% of Americans trust the healthcare system (Khullar, 2018). The issues of costs, confusing multiple agencies, and lack of transparency dominate the controversies leading to the trust crisis.
Therefore, this paper investigates the declining trust in the health care system from an ethical and moral position. The investigation used the four principles plus scope approach as proposed by Beauchamp and Childress. Beauchamp and Childress proposed the prima facie moral obligations on respect for non-maleficence, autonomy, justice and beneficence. The four moral obligations provide guidelines for physicians and practitioners on the best strategies to process or make ethical decisions during their practices. The respect for autonomy calls for respect of the patients and their consent before delivering their services. Confidentiality and other issues of privacy are important in enhancing patients' trust (Page, 2012). Non-maleficence focus on ensuring that the activities of the practitioners do not cause any harm to the patient whereas the beneficence ensures focus on enhancing the total benefits of the patients.
Delegate your assignment to our experts and they will do the rest.
Lastly, justice involves distributive, legal justice, and rights-based justice which enhance equality for individuals and the public at large. The model tends to be theoretical rather than practical because of the traditional aspects that disregard the system or legal aspects of the modern healthcare system (Gillon, 2014). For instance, autonomy, beneficence, and non-maleficence tend to limit decision making on the practitioners whereas organizational, governmental, agencies, and other policies influence the decision making process. Justice is broader and accounts for the major issues and factors associated with the healthcare system (Gillon, 2014). Based on the four principles plus attention to scope model of Beauchamp and Childress it is possible to analyze the legal, economic and financial issues associated with the declining trust of the healthcare system in America.
Legal issues
The ACA resulted in the health insurance coverage for every American. This requirement will hinder the access to healthcare services for the underprivileged who do not have the means to pay the premiums.
Secondly, the privacy issue is a major concern for patients with the implementation of the EHRs. The multiple data sharing involved in the current healthcare system increases the number of agencies who access patient health information thus increasing the risks of the privacy risks (Khullar, 2018).
Economic and Financial problems
According to Khullar and Rajkumar (2018), the relative value unit (RVU) system is responsible for overvaluing procedural tasks and undervaluing the cognitive tasks (Khullar & Rajkumar, 2018). The overstatement and understatements of the procedural and cognitive works have resulted in increased costs with limited or no improvement in the quality of services delivered.
The other major economic or financial problem caused by the current trust crisis is the increment of premiums with the cost of healthcare increasing. The uncompensated care and the high-cost pool due to the subsidized premiums that enable an aging population to dominate the insurance cover creates a high resource demand (Committee Opinion, 2010). It is also evident that the aging population access the most expensive services.
Analysis
This section uses the four principles plus attention to scope model of Beauchamp and Childress to analyze the legal and economic problems. Firstly, the ACA was created to enhance healthcare affordability and access to quality services for everyone. Therefore, it acknowledged the need for equality in access to healthcare services. However, the mandatory requirement of health insurance is inhibiting the accessibility of healthcare for non-insured individuals. The conflicting issue about unregistered immigrants who are also uninsured is not accounted for in the American right to quality healthcare.
However, the Hippocrates oath calls for the practitioners to save the lives of the patients regardless of their financial, status, political affiliation, religion, culture, and gender among other factors (DeCamp et al., 2017). Therefore, what should the practitioner do? Should the practitioner treat the uninsured individual or should he or she abide by the legal framework of the organization, state, and nation? These factors show that the ACA requirement for insurance cover is hindering the accessibility of healthcare services to the minorities which creates conflict in the practitioner’s service delivery. The issue of privacy protected by the Fifth Amendment of the Constitution is also proposed with respect for anonymity. Patients’ rights to privacy have been interfered with due to the agencies and multiple institutions and third parties that can access their health records (DeCamp et al., 2017). These issues have increased the distrust of technological advancement in the sector.
Distributive justice calls for the fair distribution of resources. Therefore, the continued use of the RVU system that does not focus on the quality of services delivered shows that wastage of resources in expensive technology or overvalued procedures is the main cause of the high costs of healthcare provision (Khullar & Rajkumar, 2018). Practitioners and institutions must adopt beneficence to ensure that they do not recommend treatments that expensive without any additional treatment value whereas there are cheap effective treatments. Lastly, the failure to account for reimbursement and the conflicting incentives have made the system complex and challenging to implement (Committee Opinion, 2010). Therefore, providers are likely to embrace a culture of money thus overuse the profitable services, These factors increase the exclusion of the less fortunate which is against the beneficence and justice principles of the model (Committee Opinion, 2010).
Modification to Increase Trust
Changing the system to an evidence-based, patient-centered approach and implementing an All-Payer Rate Setting (APRS) would improve the healthcare services without increasing the costs of provision. The evidence-based and patient-centered approach would facilitate the autonomy, beneficence, and non-maleficence principles whereas the APRS would inhibit market power dominance that hinders distribution of resources (DeCamp et al., 2017; Khullar & Rajkumar, 2018). Hence, facilitate distribution of resources as justified by the justice principle.
References
Committee Opinion. (2010). Forming a Just Health Care System. Obstetrics & Gynecology , 115 (3), 672-677.
DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., & Lehmann, L. et al. (2017). Ethical Issues in the Design and Implementation of Population Health Programs. Journal Of General Internal Medicine , 33 (3), 370-375.
Gillon, R. (2014). Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal Of Medical Ethics , 41 (1), 111-116.
Khullar, D. (2018, January 23). Do You Trust the Medical Profession? Retrieved April 5, 2019, from https://www.nytimes.com/2018/01/23/upshot/do-you-trust-the-medical-profession.html
Khullar, D., & Rajkumar, R. (2018, March 10). Health Care Pricing Innovation in the United States — Avenues for Reform. Journal Of Medical Ethics . Retrieved April 5, 2019, from https://www.bmj.com/sites/default/files/attachments/bmj-article/pre-pub-history/Revised%20article%2010.3.18.pdf
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision making?. BMC Medical Ethics , 13 (1).
