Health insurance, health system planning, andPresentation Transcript
Health insurance, health system planning, and rationing of resources Valued Care that is not cost-worthy
• 87 y.o Hannah wants to have CABG to relieve her intermittent chest pain • Her MD does not support the idea because of the risk • HMO costs also come into concern accompanying a possible surgery with high risk of complications •The HMO medical director has to authorize the CABG What is the problem?
What is the ethical dilemma? Nonmaleficence The MD wants “to do no harm” This surgery could lead to potential death, when less invasive treatment is a possibility (Ex: Stent placement with a Heart Catherization) Autonomy Hannah wants the surgery and is not afraid of dying Her priority is ceasing the chest pain It is Hannah’s right according to the Self Determination Act that she fully participate in her care
What will prolong life and avoid suffering? What benefit Hannah the most?
She is competent and able to fully participate in her care, however, it is the MD’s responsibility to prevent and harm and only provide care that will encourage Beneficence.
Is there not the possibility of a less invasive treatment to address and correct Hannah’s intermittent chest pain? (Heart Cath/Meds)
Are there any children that could help with the situation?
Hannah did have a little hesitation, however, at this point is focused relieving her chest pain, could more education help?
What if an ethics team is brought in to assist the MD with his decision
Can the chest pain be relieved by meds, while the pros and cons are weighed more thoroughly?
Is there possibly some reason that Hannah has no will to go on and the surgery could possibly put an end to her suffering?
Hannah is entitled to just care, regardless of her age, so if the MD does decide that the benefit of the CABG outweighs the risk, then the insurance has to comply. They cannot deny medically necessary coverage, however, if it is not necessary, reimbursement can be denied.
Yes, the MD can propose a plan, consult the ethics team, and deliver the information to the HMO medical director. However, Hannah has to be willing to cooperate with any other adjunct therapy that may relieve her chest pain. Ultimately, it is hannah’s decision!!Patient autonomy is paramount This is a dilemma that seems to be fixable, because there are less invasive measures to alleviate chest pain, Hannah’s primary concern. However, it needs collaboration between the MD, Hannah, and any family she may have. And by golly, whatever her cardiologist finds to be the best treatment for her and her disease, the HMO has to pay, because it will be a lifesaving measure and is a necessity to her care. She will not survive long without intervention.