Ethics in Health Services Management

Question 1 

Legal consent is the process of agreement between the patient and the doctor or medical practitioner about the acceptable proceedings concerning the health of the patient. This means that the doctor listens to what the patient is saying, and notes down what the patient says that he or she is most comfortable with in relation to their health, and any form of treatment towards the patient. In the same way, the caregiver, or the medical practitioner must also be transparent with the patient about the treatment to be provided, as well as any possible risks associated with this. This is called informed consent (Darr, 2011). For a patient to be considered to have given informed consent he or she must be well informed by the medical practitioner about the risks and benefits. The patient should also be in a position where they show they understand what they are saying ‘yes’ or ‘no’ to, and that they fully understand the risks associated (Darr, 2011). The case of the elderly woman is a good example of informed consent where she was accepting of the fact that the surgery suggested would have risks. She also understood that one of those risks would be that she could be put in a machine for life support. She was however sure that this is not what she wanted and was ready for the eventuality of death if she had to be put under a machine. She, therefore, demonstrated decision-making capacity (Darr, 2011). 

Question 2 

The case used in the first question is one that depicts the issue of informed consent, as well as a real-life application of patient centred care. The elderly patient was adamant that she did not want to be supported by a machine, and that she was ok with death if it meant that she was free of the machine. She made this very clear both to her doctor, and her two children, one of whom was her legal healthcare agent. However, she was speaking when she woke up after the surgery, she also stated that she was not ready to die, but was still not willing to be under the machine (Darr, 2011). This implies that she would have preferred her physician to assist in her death, as opposed to herself taking her own life. This form of intervention is referred to as euthanasia. The term euthanasia should not be confused with the term Physician-assisted Suicide (PAS). PAS is a whereby a patient is provided for by the physician a lethal substance that is available for the patient to use at their own time, and when they feel they are ready (Darr, 2011). Euthanasia, on the other hand, is whereby the patient requires that the physician take an active role in the administration of the lethal substance (Darr, 2011). 

Question 3 

In this regard, marketing as the ‘leader’ or as the ‘best’ organisation in the market in providing for a certain service can be a good way to access a wider customer base. However, managed care organisations usually face the problem of not being cost effective for the consumer, and so they are often underutilized by consumers (Darr, 2011). However, advertising as the best can have the effect of allowing the consumers to try out the services, and in the case where the government is able to recognize the MCO as a firm that provides high-quality health care, this could attract a contract where the government can supplement which then reduces costs for the consumers, and therefore, a wider rate of resource utilisation (Darr, 2011). 

Question 4 

Managed Care Organisations (MCO’s) are organisations that have a connection with other third-party sponsors such as the government in the provision of quality health care. Unlike traditional organisations, MCOs are delivery systems that are organised to provide health care that is well utilized and that is of high quality. MCO’s, however, are expensive ventures and so, in some cases, there is a need to reduce the number of utilizers of the service, as a way to reduce cost. The methods used to this can vary where the considerations made are based on whether to deal with the rate of users, or whether to deal with the medical practitioners who work under the MCO (Darr, 2011). One way to reduce cost is to turn heavy users to light users of the services provided and the resources made available for use. This can be done by increasing the process of these services in order to reduce the number of cases. Additionally, the MCO can use financial incentives for the medical practitioners which in turn can reduce heavy users by reducing the number of referrals to the MCOs from the other health practitioners (Darr, 2011). 

Question 5 

Physicians in an MCO program are often subject to certain constraints that can affect hem negatively, and in a few cases, positively. However, the majority of these constraints are negatively felt by physicians. The most noticeable of these constraints is the lack of patient involvement. Many physicians require that a patient in decision-making about their health, and this can be a problem if the MCO is not transparent about this (Darr, 2011). Additionally, a physician is affected by the Medicaid policies imposed by the MCO, one of them being value-based payments. MCO can sometimes decline meeting the demands of the physicians which can sometimes prove problematic for the physician. Lastly, another challenge is that of transparent and easy transfer of medical records among the physicians. Exchange of health records is important as it allows the practitioners to take care of the patient as was intended while the lack of it, is dangerous to the doctor’s reputation as well as to patient’s health (Darr, 2011). 

Question 6 

Micro-allocation is the process of providing health services to a select number of individuals to receive a scarce service or utilise a scarce health care resource. Macro allocation, on the other hand, is the distribution of healthcare resources to the public through public health policies but which also involves some form of patient selection (Darr, 2011). A good example of macro selection is where the government provides vaccination programs to a selected region with the hope of reducing the prevalence of certain disease. A micro-allocation, on the other hand, is such as the global organ transfusion network which is only made available to people who are in dire need of a new organ, and who have qualified to receive it. 

Question 7 

The case of Karen Ann Quinlan is a clear depiction of the aspect of medical futility. This is because, in the case of Karen Ann, the patient is beyond any hope of recovery, and yet, machines are put in use to support the patient’s life even into the dying process. Such is medical futility, by definition, it is the state where a patient is being kept alive by use of machines but where they are in a state of health that is no longer recoverable from, and where the quality of life s a real debate. According to (Darr, 2011),Darr says that “the futility theory has quantitative and qualitative aspects”. This means that the futility theory must be followed through based considerations about the quantity in terms of economic cost that is incurred through continued futility treatment, and the quality that is to be gained, in terms the possibility of full recovery, by the patient (Darr, 2011). 

Question 8 

Having completed this class, what I have learnt that I had no knowledge of prior to this class is one what issue are important to physicians who are affiliated with an MCO. Physicians are often the beneficiaries of MCOs where they can provide good health care for good wages and benefits. However, despite this being an advantage, they are often more concerned about the wellbeing of the patient as is demonstrated by their need for patient involvement in decision making (Darr, 2011). Additionally, while financial incentives are effective at persuading physicians, they would prefer to feel well utilized and of good service to the community. 

References 

Darr, K. (2011). Ethics in Health Services Management, 4th Edition.  Journal For Healthcare Quality ,  27 (3), 55. doi:10.1097/01445442-200505000-00012