Chapter 23 Health Care Reform What About Those .docx

Chapter 23
Health Care Reform: What
About Those Left Behind?
3
Ethics Concerns for Three Populations
Without Health Insurance
• Individuals who are not documented.
• Individuals eligible for Medicaid but not
enrolled.
• Individuals exempted from purchasing
insurance because of financial burden.
4
Ethical Analysis

• Analysis includes
• Nonmaleficence.
• Beneficence.
• Paternalism vs. autonomy.
• Distributive justice.
• Code of Ethics of American Nurses
Association.
5
Review the Case Studies
• Population needing renal dialysis.
• Population of women who are pregnant &
non-documented.
• Ethical analysis applied.
6
Review the Ethical Guidelines for RNs
• ANA Code of Ethics.
• ANA’s Social Policy Statement.
• ANA & other specialty nursing association’s
standards of practice.
• Analysis of 5 of 9 provisions of ANA Code.
7

Ethical Analysis with Other Ethical Theories
• Deontological analysis.
• Utilitarianism analysis.
• Use of religions’ stances on ethics.
8
Case Study—Medicaid State
Differences
• Proposed changes in Medicaid accessibility &
services.
• Rationale for proposed changes.
• Tension between Affordable Care Act
provisions & state Medicaid rules.
• Concerns of non-access to Medicaid services.
9
Advocacy Strategies
• Work on electoral campaigns.
• Have intentional relationships with elected
representatives.
• Be self-educated.

• Engage in lobby activities.
• Invest time, money, & energy in one’s
professional associations.
10
Application of Advocacy Strategies
• Discuss the listed examples in the chapters.
How could you apply them?
• Make parallel conclusions with your own
professions.
11
What About Those Left Behind?
• There are concerns about populations not
covered by the PPACA.
• Be sure to analyze the ethics of such non-
access.
• Be able to describe policy interventions to
accompany your ethical analyses and stances.
12

In Summary…
13
Slide Number 1Chapter 23Slide Number 3Ethics Concerns for
Three Populations Without Health InsuranceEthical
AnalysisReview the Case StudiesReview the Ethical Guidelines
for RNsEthical Analysis with Other Ethical TheoriesCase
Study—Medicaid State DifferencesAdvocacy
StrategiesApplication of Advocacy StrategiesWhat About Those
Left Behind?In Summary…
Required Resources
Text
Powers, S. K., & Dodd, S. L. (2017). Total fitness & wellness,
the Mastering Health edition (7th ed.). Retrieved from
https://redshelf.com
· Chapter 2: General Principles of Exercise for Health and
Fitness
· Chapter 3: Cardiorespiratory Endurance: Assessment and
Prescription
· Chapter 4: Improving Muscular Strength and Endurance
· Chapter 5: Improving Flexibility
· Chapter 6: Body Composition
Articles
Garber, C. E., Blissmer, B., Deschenes, M., Franklin, B. A.,
Lamonte, M. J., Lee, I., Nieman, D. C., & Swain, D. (2011).
Quantity and quality of exercise for developing and maintaining
cardiorespiratory, musculoskeletal, and neuromotor fitness in
apparently healthy adults: Guidance for prescribing
exercise (Links to an external site.). Medicine & Science in
Sports & Exercise, 43(7), 1334-1359. doi:
10.1249/MSS.0b013e318213fefb
· In this article, exercise recommendations for healthy adults
and adults with chronic diseases are provided.
Cardiorespiratory, resistance training, flexibility, and

neuromuscular recommendations are explained. Health benefits
of a regular exercise program are also discussed. This article
will help you with your written assignment this week.
Burt, V. (Writer), & Breitenmoser, K. (Director & Producer)
(2010). The body in motion: Fitness, skill, and training [Video
file]. Retrieved from
https://fod.infobase.com/OnDemandEmbed.aspx?token=42237&
wID=100753&plt=FOD&loid=0&w=640&h=480&fWidth=660&
fHeight=530
· In this video, viewers will learn practical tests that measure
the health-related and skill-related components of fitness, how
to apply the FITT principle—frequency, intensity, type, and
time—to a training regimen, and what happens to the
cardiorespiratory system during exercise. This video will assist
you with your journal and written assignment this week.
Web Pages
American College of Sports Medicine. (2018). Updated physical
activity guidelines now available (Links to an external site.).
Retrieved from https://www.acsm.org/read-
research/newsroom/news-releases/news-
detail/2018/11/12/updated-physical-activity-guidelines-now-
available
· This website provides the updated physical activity guidelines
for all age groups. Benefits of exercise are also discussed as
well as the risks of being inactive.
Accessibility Statement does not exist
Privacy Policy (Links to an external site.)
Office of Disease Prevention and Health Promotion. (2018).
Physical activity (Links to an external site.). Retrieved from
https://health.gov/paguidelines/
· This web page provides information about the physical
activity guidelines for exercise. Physical activity guidelines for
children, adolescents, adults, and older adults are provided.
Health benefits are also discussing. This webpage will assist
you in your written assignment for this week.
Accessibility Statement (Links to an external site.)Privacy

Policy (Links to an external site.)
Recommended Resources
Websites
Exercise is medicine (Links to an external site.).
(http://exerciseismedicine.org/)
· This website provides a wealth of resources for including
physical activity in treatment plans for the health and wellness
professional. This website may assist you with your written
assignment this week.
Accessibility Statement does not exist.
Privacy Policy
Chapter 22
A New Era of Health Care: The
Ethics of Health Care Reform
3
Health Care Reform in the U.S.
• HR 3590 and HR 4872 signed into law in 2010

by President Obama.
• These acts represent a century of efforts to
provide access to high quality, affordable
health care.
• Access, cost, and quality are the triumvirate
mantra of health care reform.
4
Health Care Reform in the U.S.
• There are three ways to provide universal
coverage for populations:
– The Bismarck Model.
– The Beveridge or National Health Service
Model.
– The National Health Insurance Model.
5
A Bit of History
• Otto von Bismarck introduced universal
healthcare insurance in Germany in 1883.
• Other European countries provided universal
health care for a variety of reasons.
• European plans evolved from wage protection

motives to providing medical and hospital
coverage.
6
A Bit of History for the U.S.
• Theodore Roosevelt was the first to support
universal health care insurance.
• His ideas were not supported by labor,
medical societies, the insurance business, and
business interests.
• Universal coverage was excluded from the
Social Security Act of 1935.
7
• In 1939-1943, attempts were made to create
national health insurance, but they were not
successful.
• In 1948, President Truman campaigned
strongly for national health insurance.
• 71% of Americans were in favor of universal
coverage, but it never passed in Congress.
8

• In 1960, there was a new effort to address the
healthcare coverage of a new group: the
elderly.
• President Johnson’s political skills contributed
to the passage of Medicare in 1965.
• Medicaid, designed to provide care for needy
children, was also passed in 1965.
9
• In 1971, President Nixon proposed a plan for
compulsory employment-based health
insurance that died a quick death.
• The Clinton administration attempted health
care reform with the Clinton National Health
Security Plan.
• This plan had endorsements, but died in
committee.
10

What Contributed to PPACA?
• The percentage of the population without
insurance reached 16%
• Shortages of professionals lead to
compromised access to care.
• Costs for health care continued to rise and
quality lapses continued.
• Health care reform sought to: increase access,
improve quality and control costs.
11
Ethics and Health Care Reform
• Numerous groups conclude that there is
fundamental right to health care. Including:
• WHO, The United Nations, The Organization of
American States, and The U.S. Declaration of
Independence.
• Religious traditions also support it.
12
Key Areas of PPACA
• All Americans and legal immigrants must have

health insurance.
• Businesses must provide health insurance.
• Medicaid eligibility is extended.
• Medicare benefits are improved.
13
Key Areas of PPACA
• Insurance reform is extensive.
• No lifetime limits are allowed.
• Preventive care must be provided with no
copays.
• Minimum loss ratios are required.
• States can receive assistance to set up
insurance exchanges.
14
Key Areas of PPACA
• The Act supports quality efforts.
• New research is supported.
• Coordination and integration of services is
required.
• Incentives are based on quality efforts.

15
Key Areas of PPACA
• The Act is concerned with adequate workforce
an coverage for underserved areas.
• Incentives are provided to increase the
balance of health care professionals.
• The Act is funded by new taxes, savings, and
penalties.
16
PPACA Is Phased In
• The provisions of the Act will be phased in
through stages beginning in 2010.
• Note the changes by year given in the Chapter.
• The Act will not be fully implemented until
2020.
17
Justice and PPACA
• A just system would provide access to high

quality care for those who need it.
• How does PPACA increase access, improve
quality, and control costs?
18
Justice and PPACA
• Access is increased because more people will
be insured.
• Supply and distribution of personnel to meet
the needs of the newly insured is addressed.
• Insurance reform and subsidies addresses
cost.
19
Justice and PPACA
• However, PPACA does fall short in some areas.
• There will still be 18-20 million uninsured
Americans.
• The effectiveness of workforce incentives and
quality programs remains to be seen.
20

Justice and PPACA
• However, PPACA does fall short in some areas.
• PPACA is predicted to slow the costs of health
care.
• However, costs are predicted to continue to
rise faster than the GDP and inflation.
21
Is Health Care Reformed?
• Given the need for addressing the three areas
of access, costs, and quality, PPACA will
continue to be a work in progress.
• The healthcare system will continue to be
refined and reformed in the years to come.
22
In Summary…
23
Slide Number 1Chapter 22Slide Number 3Health Care Reform
in the U.S. Health Care Reform in the U.S. A Bit of HistoryA
Bit of History for the U.S. A Bit of History for the U.S. A Bit

of History for the U.S. A Bit of History for the U.S. What
Contributed to PPACA?Ethics and Health Care ReformKey
Areas of PPACAKey Areas of PPACAKey Areas of PPACAKey
Areas of PPACAPPACA Is Phased In Justice and PPACAJustice
and PPACAJustice and PPACAJustice and PPACAIs Health
Care Reformed?In Summary…
Chapter 21
Ethics Issues in Disaster Relief
3
Definitions
• A disaster is an unexpected claustrophobic
event or situation that depletes the survival
resources and supplies in a relatively short
timeframe.
• Disasters are generally divided into two
categories: natural and anthropogenic.
• Disasters not only influence the environment,
and society but also the human experience.

4
Government Disaster Planning and
Response
• September 11, 2001 created a movement to
upgrade America’s ability to plan for all future
disasters that continues to this day.
• When there is a disaster, programs require the
partnership of government (regional, state,
and local), voluntary organizations, health care
systems including first responders, and
individual citizens to work as a massive team.
5
Response
• One response was the creation of the
Department of Homeland Security (DHS).
• DHS is responsible for security at airports,
protecting cargo, and sharing information.
• The DHS now includes several emergency
management agencies.
6

Response
• FEMA responds to both local and national
disasters.
• It coordinates resources for disaster
responses.
• It is also involved in helping people be
prepared for disasters.
• FEMA provides direct assistance to qualified
disaster survivors.
7
Response
• The CDC tracks natural and human-made
disasters and conducts research on ways to
respond to the aftermath of these events.
• It provides information on a wide variety of
topics to help businesses, hospitals,
communities, and individuals prepare for
disasters.
8

Response
• The CDC is also involved in researching the
aftermath of disasters to improve response
times.
• It has also developed an national stockpile of
pharmaceuticals to respond to needs in a
disaster.
• The CDC also provides education on disaster
preparedness.
9
Response
• The American Red Cross (ARC) responds to
immediate needs and relieves suffering
particularly when disaster strikes on a local,
regional, and national basis.
• Volunteers are trained by the ARC to provide
services in a variety of disaster situations.
10
Other Voices on Government
Response

• Redlener suggests that governments have
much more to do.
• A plan is needed to set benchmarks, correct
methods of overseeing disaster planning,
create accountability standards, and make the
reduction of threats a priority among its
features.
11
Ethics Issues and Government Disaster
Planning and Response
• Ethical responsibility begins with the plan
itself.
• Conflicts of interest must be addressed.
• The plan must balance utilitarian ideas with
the deontology of protecting individual rights.
12
• Triage is an example of an utilitarian ethics
application to a disaster situation.
• Categorization of injuries is needed.

• Even when triage is needed, the community’s
view must be considered.
• Humanitarianism does not allow some to be
left behind without treatment.
13
• Autonomy is another ethical issue for disaster
planning.
• How far do the rights of the individual go
when they can negatively affect the
community?
• Balance between utility and autonomy needs
to be a part of the plan.
14
• Social justice is also an ethics issue.
• For when large amounts of capital (in the
billions of dollars) are involved, the potential
for fraud, abuse, and corruption exists.

• Communities do not find it just if individuals
profit unethically from disasters.
15
Health Care Organizations and
Disaster Planning
• Hospitals and health care systems respond
when disasters occur.
• The Joint Commission mandates a disaster
management plan with standards and
requirements.
• Plans are developed using a hazard analysis
and are based on six capability areas.
16
Health Care Organizations and
Disaster Planning
• The ASPR provides guidance for implementing
the Hospital Preparedness Program (HPP).
• The ASPR identified eight areas that are
needed for disaster preparation.
• Guides are provided for assessing and creating

preparedness plans for all eight areas.
17
Ethics Issues for Organization Disaster
• Concepts of utilitarianism and deontology
must be balanced when dealing with the use
of scarce resources.
• Using the “greatest good for the greatest
number” alone can lead to severe ethical
problems for organizations and first
responders.
18
• Conflicts of duty can exist for those who
respond to disasters?
• To whom do they owe a primary duty: the
community or their own families?
• Planning needs to consider the families of
staff so that the conflict can be reduced.
19

• Social justice is also an ethical issue.
• The community’s values and concept of
fairness must be considered in disaster
planning and response.
• Plans must also address autonomy,
nonmaleficence, beneficence, and justice.
20
Individual Response to Disasters
• Despite news coverage of disasters, the
American public continues to be unprepared.
• It seems to be part of human nature to think
about worst-case situations.
• Vulnerable populations such as low income
families are often the least prepared for
dealing with emergencies.
21

• American should be “Red Cross Ready’ in the
event of an emergency.
• The Red Cross gives guidelines on what an
individual or family needs to be prepared.
• Preparedness also requires that individuals
develop a plan in the event of an emergency.
22
• The CDC suggests that individuals may have to
shelter-in-place when a disaster occurs.
• Choose a room in the home or business as a
prepared shelter.
• The room should be equipped to be “Red
Cross Ready” for emergencies.
23
• Citizens be physically prepared and also
mentally ready for disasters and for survival.
• They need to be physically fit to survive and
be CPR and first aid trained

• They also need to be aware of their situation
at work, home, and the community.
24
• There also needs to be a family plan for
dealing with emergencies.
• The plan should address how to care for the
elderly or disabled.
• Families should be prepared for evacuation or
sheltering in place.
• Communication issues should also be
addressed.
25
Ethics Implications for Individual
Response to Disasters
• Disasters can cause a retreat to survival mode
where dignity and rights of others are ignored.
• People also tend to expect their governments
to respond in whenever any type of
emergency occurs.
• People may have to handle emergencies on

their own because help may not be eminent.
26
• Autonomy is another ethical issue for
individuals.
• Government and organizations use higher and
higher levels of technology as prevention for
potential disasters.
• How much privacy and autonomy is lost
versus the benefits gained?
27
• Beneficence is also an issue for individuals.
• Without the acts of beneficence, many will
not survive.
• However, an ethics issue exists concerning the
boundaries of beneficence.
28

In Summary…
29
Slide Number 1Chapter 21Slide Number
3DefinitionsGovernment Disaster Planning and
ResponseGovernment Disaster Planning and
ResponseGovernment Disaster Planning and ResponseOther
Voices on Government ResponseEthics Issues and Government
Disaster Planning and ResponseEthics Issues and Government
Disaster Planning and ResponseHealth Care Organizations and
Disaster Planning Health Care Organizations and Disaster
Planning Ethics Issues for Organization Disaster Planning and
ResponseEthics Issues for Organization Disaster Planning and
ResponseEthics Issues for Organization Disaster Planning and
ResponseIndividual Response to Disasters Individual Response
to Disasters Individual Response to Disasters Individual
Response to Disasters Individual Response to Disasters Ethics
Implications for Individual Response to DisastersEthics
Implications for Individual Response to DisastersEthics
Implications for Individual Response to DisastersIn Summary…

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