This document discusses factors that influence payments to physicians, including moral, ethical, political and economic considerations. It focuses on three key moral/ethical dimensions in American society that must be considered when developing payment controls: the love of liberty and independence, the passion for fairness and equity, and the urge for volunteerism. Any solution that places controls on physician payments must respect these enduring American institutions and principles that are deeply rooted in U.S. history and culture.
This document summarizes a research paper on the individual, familial, and societal factors that lead to sex trafficking as well as the physical and mental health effects on victims. It discusses how health professionals are often the only providers that victims encounter while being trafficked, but many lack knowledge to properly identify and assist victims. The paper reviews literature highlighting common factors that increase vulnerability to sex trafficking such as poverty, abuse, and dysfunctional families. It also outlines the short and long-term health consequences for victims, including sexually transmitted infections, unwanted pregnancy, and mental health issues. The document advocates for training health providers to recognize signs of trafficking and connect victims to necessary medical and social services.
Values in Health Care Systems: a Journey of Health care professionals in conc...Ruby Med Plus
This research paper gives broad picture of Indian health care system in terms of health care values. It defines values in general and values in health care system. This research paper is divided in two parts. First part will address two research questions in support with aggressive literature review i.e., (a) How values diversity and values conflict affect health care teams while supporting appropriate health care organization values? (b) How health care managers match their values with organization values? Second part of study address two research questions (a) what are appropriate research models of value systems which can be applied to health care organisations? (b) How do value systems explain organisation behaviour in Health care organizations?
State of the Puppet Community: PuppetConf 2014Dawn Foster
Co-Presenter: Kara Sowles
The Puppet Community is one of the things that makes Puppet so special, partly because it is filled with amazing, helpful Puppet users from all over the world. It's a great place to get answers to questions, but the real magic is with the people who are contributing answers, bug reports, help, pull requests, and much more. This session will talk about the many ways that people can contribute to the community.
This session will cover:
* what the community looks like now with some real data from our metrics.
* plans we have for improving the community over the next year (or so).
* how you can contribute to Puppet and our community.
Jeremy Adams and Lizzi Lindboe delivered this talk at PuppetConf 2015. You'll learn some REST / HTTP API basics, hear about some useful CLI tools, and get some useful examples that you can try on the Puppet Learning VM or any Puppet Enterprise install.
This document introduces Grape, an open-source Ruby framework for building REST-style web APIs. It discusses how to install Grape, create CRUD actions, add namespaces and versioning, validate parameters, add authentication, and support different API formats. It also compares the performance of Grape to Rails APIs, finding that Grape has a higher request throughput and lower latency. Resources for learning more about Grape include its Google Group, YARD documentation, and wiki.
VMworld 2013: VMware and Puppet: How to Plan, Deploy & Manage Modern Applicat...VMworld
VMworld 2013
Nigel Kersten, Puppet Labs
Becky Smith, VMware
Learn more about VMworld and register at http://www.vmworld.com/index.jspa?src=socmed-vmworld-slideshare
This document summarizes a research paper on the individual, familial, and societal factors that lead to sex trafficking as well as the physical and mental health effects on victims. It discusses how health professionals are often the only providers that victims encounter while being trafficked, but many lack knowledge to properly identify and assist victims. The paper reviews literature highlighting common factors that increase vulnerability to sex trafficking such as poverty, abuse, and dysfunctional families. It also outlines the short and long-term health consequences for victims, including sexually transmitted infections, unwanted pregnancy, and mental health issues. The document advocates for training health providers to recognize signs of trafficking and connect victims to necessary medical and social services.
Values in Health Care Systems: a Journey of Health care professionals in conc...Ruby Med Plus
This research paper gives broad picture of Indian health care system in terms of health care values. It defines values in general and values in health care system. This research paper is divided in two parts. First part will address two research questions in support with aggressive literature review i.e., (a) How values diversity and values conflict affect health care teams while supporting appropriate health care organization values? (b) How health care managers match their values with organization values? Second part of study address two research questions (a) what are appropriate research models of value systems which can be applied to health care organisations? (b) How do value systems explain organisation behaviour in Health care organizations?
State of the Puppet Community: PuppetConf 2014Dawn Foster
Co-Presenter: Kara Sowles
The Puppet Community is one of the things that makes Puppet so special, partly because it is filled with amazing, helpful Puppet users from all over the world. It's a great place to get answers to questions, but the real magic is with the people who are contributing answers, bug reports, help, pull requests, and much more. This session will talk about the many ways that people can contribute to the community.
This session will cover:
* what the community looks like now with some real data from our metrics.
* plans we have for improving the community over the next year (or so).
* how you can contribute to Puppet and our community.
Jeremy Adams and Lizzi Lindboe delivered this talk at PuppetConf 2015. You'll learn some REST / HTTP API basics, hear about some useful CLI tools, and get some useful examples that you can try on the Puppet Learning VM or any Puppet Enterprise install.
This document introduces Grape, an open-source Ruby framework for building REST-style web APIs. It discusses how to install Grape, create CRUD actions, add namespaces and versioning, validate parameters, add authentication, and support different API formats. It also compares the performance of Grape to Rails APIs, finding that Grape has a higher request throughput and lower latency. Resources for learning more about Grape include its Google Group, YARD documentation, and wiki.
VMworld 2013: VMware and Puppet: How to Plan, Deploy & Manage Modern Applicat...VMworld
VMworld 2013
Nigel Kersten, Puppet Labs
Becky Smith, VMware
Learn more about VMworld and register at http://www.vmworld.com/index.jspa?src=socmed-vmworld-slideshare
The document discusses various aspects of justice in healthcare, including distributive, legal, and rights-based justice. It notes that distributive justice involves fair distribution of limited resources according to principles like need, effort, and merit. The document also discusses concepts like triage in emergency situations and debates around rationing healthcare resources. While many policies aim to consider efficiency and cost, ethical concerns also need to be addressed, such as ensuring access to life-saving care regardless of cost or ability to pay. Overall, the document examines different frameworks for justice in healthcare and debates around fairly allocating limited resources.
The document discusses several concepts related to justice in healthcare including distributive justice, legal justice, and rights-based justice. It notes that distributive justice concerns the fair distribution of limited healthcare resources according to principles like need, effort, and merit. Legal justice refers to applying legislation to protect victims and punish lawbreakers. Rights-based justice focuses on respecting individuals' rights rather than just applying law. The document also examines ethical challenges around rationing healthcare resources and prioritizing patients in situations with limited resources.
Historical factors that have influenced health care, Health ManagementArdavan Shahroodi
The document discusses five historical factors that have influenced how healthcare is delivered in the US: 1) The authority of the medical profession in organizing care, 2) Viewing healthcare as a market commodity, 3) Limited role of government in healthcare, 4) Influence of technology, and 5) Effect of medical malpractice litigation. It analyzes each factor in more depth, particularly the role of physicians in establishing standards and controlling financing mechanisms, and how this led to physicians operating as self-interested entrepreneurs and healthcare as a market-based system. The document also discusses the increasing but still limited role of government in healthcare financing and regulation.
County Hospital Director of Public Relations and Ethics.docxsdfghj21
The document discusses several ethical issues facing the Director of Public Relations and Ethics at County Hospital including abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating press release flyers outlining the hospital's position and rationale on each issue.
Project County Hospital Director of Public Relations and Ethics.docxwrite22
The document provides background information on ethical issues facing the director of public relations and ethics at County Hospital. It discusses five topics: abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating one-page press release flyers outlining the hospital's position on each issue.
There are several factors that influence how organ transplants are allocated. In the US, financial factors like insurance status and ability to pay play a role, while in the UK the National Health Service rationing explicitly limits certain expensive treatments. Both systems have benefits and weaknesses, and it can be argued that denying treatment is ethically easier in the UK system due to its explicit rationing. There is no consensus on the most ethical approach.
This document provides an ethical framework for analyzing public health dilemmas. It distinguishes three major philosophical approaches: utilitarianism, which is based on consequences and maximizing overall well-being; liberalism, which focuses on individual rights and opportunities; and communitarianism, which emphasizes virtue and the appropriate social order. The document explores each approach in depth and discusses how they relate to public health policy debates. It concludes that health professionals need enhanced skills in applied philosophy to improve policy deliberations on the inherent ethical issues in public health.
Healthcare Policy and Advocacy for Improving Population Health.pdfbkbk37
This document provides instructions for students to respond to two discussion posts by other students on the topic of the Affordable Care Act. Students are asked to analyze how cost-benefit analysis affected efforts to repeal/replace the ACA and how voter analysis may impact legislative decisions on policies like Medicare and Medicaid. Students must post an original discussion by day 3 and respond to two other students' posts with expansions or challenges to their explanations and examples.
EHR In Health Care Essay
Health Care Professionals Essay
Is Health Care a Right or a Privilege? Essay
Health Care Provider Essay
Essay on Quality Health Care
Healthcare in the United States Essay
The Cost Of Health Care Essay
Us vs Canada Health Essay
Managed Care Essay
Primary Health Care Essay examples
Health Care Essay
Essay On Health Care
The Problem Of Health Care Essay
Part IILaw and Ethics in Health Care AdministrationC.docxdanhaley45372
Part II
Law and Ethics in Health
Care Administration
Chapter 4
Patient Empowerment, Consent, and
Rights
Chapter 5
Privacy and Confidentiality
Chapter 6
Medical Mistakes and Patient Safety
Brand New Images/Iconica/Getty Images
The chapters in Part II deal with ethical issues regarding patients. Chapter 4 examines the patient empow-
erment movement and the importance of informed consent and patient rights. Chapter 5 delves into the
concepts of privacy and confidentiality as well as the legalities concerning the ethical notions of respecting a
person’s right to privacy and confidentiality. Chapter 6 discusses the ways in which ethical health care orga-
nizations address medical mistakes and examines the legal, regulatory, political, and administrative concerns
surrounding this issue, including protecting organizations from legal liability.
69
Associated Press/Brian Kersey
Patient Empowerment,
Consent, and Rights 4
Learning Objectives
1. Explore different forms of power in health care and their relevance to ethical organizational leadership.
2. Describe the patient empowerment movement.
3. Describe the history and importance of informed consent in ethical health care.
4. Critically analyze what informed consent requires of practitioners in health care contexts.
5. Articulate the benefits as well as the dangers of the consumer model in health care.
6. Explore whether and why health care is fundamentally different from commercial enterprises.
7. Investigate the patient bills of rights movement and the Affordable Care Act’s Patient’s Bill of Rights.
70
CHAPTER 4Section 4.1 Power in Health Care
In their influential study of more than 60,000 managers and other leaders, Jim Kouzes and Barry
Posner (2007) discovered a connection between people’s ability to achieve leadership and the fre-
quency with which they use the word “we” (p. 12). The dynamics of leadership demonstrate that,
when organized around clear principles and direction, a group of people can achieve goals that
would not only be beyond the ability of one person, but also beyond that of the same number of
people separately. This is the basic definition of synergy.
Synergy can also be applied to the health care professional-patient relationship. When patients
collaborate with their providers to achieve agreed-upon goals, they enjoy higher satisfaction with
their care and benefit from better outcomes (Hibbard & Greene, 2013). Patients who feel power-
less in their provider-patient relationship tend to respond defensively, even taking an adversarial
stance, and are often deemed “noncompliant” (Becker, 1985, p. 539) by health care professionals.
The ethical leader will want to distribute power evenly between the caregiver and patient in order
to achieve better results and facilitate healing. From a managerial perspective, studies show that
leaders who distribute power throughout the organization increase the cooperation of mem-
bers (Fuller, Morrison, .
CHAPTER 7The policy processEileen T. O’GradyThere are tJinElias52
CHAPTER 7
The policy process
Eileen T. O’Grady
“There are three critical ingredients to democratic renewal and progressive change in America: good public policy, grassroots organizing and electoral politics.”
Paul Wellstone
Nurses can more strategically and effectively influence policy if they have a clear understanding of the policymaking process. Conceptual models can help to organize and interpret information by depicting complex ideas in a simplified form; to this end, political scientists have developed a number of conceptual models to explain the highly dynamic process of policymaking. This chapter reviews two of these conceptual models.
Health policy and politics
Health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health and health care (see Box 7.1 for policy definitions). A clear understanding of the points of influence to shape policy is essential and includes framing the problem itself. For example, if nurses working in a nurse-managed clinic are troubled by staff shortages or long patient waits, they may be inclined to see themselves as the solution by working longer hours and seeing more patients. Defining and framing the problem is the first step in the policy process and involves assessing its history, patterns of impact, resource allocation, and community needs. Broadening and framing the problem to influence or educate stakeholders at the local, state, or federal level could include advocating for better access or funding for nursing workforce development (see Box 7.1).
BOX 7.1
Policy Definitions
Policy is authoritative decision making related to choices about goals and priorities of the policymaking body. In general, policies are constructed as a set of regulations (public policy), practice standards (workplace), governance mandates (organizations), ethical behavior (research), and ordinances (communities) that direct individuals, groups, organizations, and systems toward the desired behaviors and goals.
Health policy is the authoritative decisions made in the legislative, judicial, and executive branches of government that are intended to direct or influence the actions, behaviors, and decisions of others (Longest, 2016).
Policy analysis is the investigation of an issue including the background, purpose, content, and effects of various options within a policy context and their relevant social, economic, and political factors (Dye, 2016).
The next step is to bring the problem to the attention of those who have the power to implement a solution. Other key factors to consider include generating public interest, the availability of viable policy solutions, the likelihood that the policy will serve most of the people at risk in a fair and equitable fashion, and consideration of the organizational, community, societal, and political viability of the policy solution.
Public interest is a fascinating dynamic ...
This document discusses procedural justice in resource allocation decisions in healthcare. It presents two case studies from Oregon regarding different approaches to allocating scarce healthcare resources: 1) Allocation by expert panels, which led to public outcry over denied benefits, and 2) Allocation by community consensus, where Oregon engaged the public to articulate healthcare values and priorities. The document emphasizes that just processes are needed for ethical resource rationing and that solely relying on healthcare experts may not be sufficient - democratic deliberation involving affected communities is also important to develop policies with moral legitimacy.
The student writes a letter to an honorable Simon bringing attention to the pressing issue of rising healthcare costs among elderly Hispanic Americans in the region. This is impacting individuals' health and families' financial stability as well as the overall economy. The student urges the honorable Simon to take action by prioritizing policies that improve healthcare affordability, access, and equity for this group. Addressing the issue could significantly reduce costs for healthcare organizations and taxpayers while improving individuals' health outcomes.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
Review pages 109–110 of Essentials of Health Policy and Law as wel.docxjoellemurphey
Review pages 109–110 of Essentials of Health Policy and Law as well as the following legislation:
Examination and Treatment for Emergency Medical Conditions and Women in Labor
You are a consultant specializing in policy analysis. Based on theExamination and Treatment for Emergency Medical Conditions and Women in Labor legislation, as well as the situation that follows, you will complete a policy analysis with 3–5 options for your client, Congresswoman Moody, to consider.
Congresswoman Moody represents a state that borders Mexico. She is up for re election next year, and she will seek another term in office.
There are many undocumented workers that reside in her district. Congresswoman Moody is vocal about the need to provide health care to all that need it, but she also believes in fiscal restraint and does not support bail-outs for private facilities. She is well aware that her state’s Medicaid budget is almost exhausted for this year, and the state’s unemployment rate remains stubbornly high.
Apart from the voters, other affected constituents include three private regional medical centers trauma units that receive referrals from five or more small facilities that have emergency departments with lesser trauma status. Also, the largest health care corporation that owns two of the three medical centers in her catchment area, and which supported her in her last bid for election with campaign funds at the allowable limit, is threatening to refuse Medicare and Medicaid patients to ensure survival in the bad economy. An increase in unfunded mandates for urgent care may push this corporation into private payer only, and Congresswoman Moody is aware that there are enough affluent families in the area to support two facilities providing only designer medicine and concierge services.
All options must:
· Be within the power of Congresswoman Moody to do
· Be consistent with Congresswoman Moody’s values, and
· Address the issue identified in the problem statement
You will:
1. Identify 3–5 options for Congresswoman Moody’s consideration
2. Identify criteria that will be used to evaluate the options
3. Identify pros and cons for each option
4. Use a side-by-side table (MS® Excel® would be appropriate for this) to assist in analyzing the options.
Submitting Your Assignment
Prepare your written Assignment in a Word and/or Excel document and save it in a location and with a name you will remember, using the following naming convention: username-assignment-unit#.doc.
Page number 109
In terms of national constitutions, a 2004 survey reported that some two-thirds of constitutions worldwide address health or health care, and that almost all of these do so in universal terms, rather than being limited to certain populations.13 For example, consider the health-related constitutional aspects of four politically and culturally diverse countries—Italy, the Netherlands, South Africa, and Poland—that have some type of “right to health”: Italy’s Constitution guarantees a ...
This document contains discussion questions and assignments for an HCA 305 healthcare administration course. It includes questions about factors that impact healthcare expenditures in the US and how US healthcare spending compares to other countries. It also addresses healthcare reform, quality improvement in hospitals, choosing healthcare providers, and the Patient Protection and Affordable Care Act. Students are asked to discuss, analyze, and provide opinions on these healthcare administration topics.
The Role of Government in the U.S. Health Care SystemAs stated in .docxsuzannewarch
The document discusses the role of government in the U.S. health care system. It notes that while health care is an important part of the social and economic systems, the current system is viewed as broken with millions uninsured and rising costs. There is debate around the proper role of government in health care, with disagreement on how best to address issues in a polarized political environment. Students are asked to consider whether health care is a right or privilege, and examine how a social, economic, technological, ethical, or legal issue impacts delivery and if it should be addressed publicly or privately.
This document summarizes an essay analyzing the economics behind physician-assisted suicide. It discusses how legalizing PAS could lead to significant cost savings in healthcare by avoiding expensive end-of-life care costs. It presents concerns that patients may feel pressure from healthcare providers, families, or themselves to choose PAS to save money. However, from an economic perspective, legalizing PAS respects individual choice and leads to more efficient allocation of limited healthcare resources. The document applies concepts like marginal costs and benefits, opportunity costs, and externalities to analyze the issue from an economic framework.
This document summarizes an essay analyzing the economics behind physician-assisted suicide. It discusses how legalizing PAS could lead to significant cost savings in healthcare by avoiding expensive end-of-life care costs. It presents concerns that patients may feel pressure from healthcare providers, families, or themselves to choose PAS to save money. However, from an economic perspective, legalizing PAS respects individual choice and leads to more efficient allocation of limited healthcare resources. The document applies concepts like marginal costs and benefits, opportunity costs, and externalities to analyze the issue from an economic framework.
The document is a research paper analyzing whether the Affordable Care Act is leading the United States toward socialism. It provides background on the ACA and defines socialism. It then examines perspectives both for and against the ACA. Those supporting the ACA argue it promotes life, liberty and happiness by expanding access to healthcare. Critics argue it increases taxes and the national debt while exacerbating doctor shortages and reducing care quality by increasing demand. The conclusion is that while the ACA promotes equality in healthcare, in practice it gives the government greater control over the system and resources, raising concerns about the country moving toward a socialized system.
LDR 7980 Capstone Essay Four Assignment Ethics and LeadershipArdavan Shahroodi
This document provides an analysis of ethics and leadership in organizations. It discusses how the modern organization structure can deprive employees of engagement needed for ethical development. Researchers found unethical decisions often stem from pressure from managers and lack of support from executives. The document recommends leaders develop strong value systems, avoid oversimplifying problems, be objective in evaluations, and seek diverse perspectives to make ethical decisions. Cultivating an authentic culture of engagement between leaders and followers is key to sustainable ethics.
LDR 7980 Capstone Essay Three Assignment Influencing Motivating and Leading t...Ardavan Shahroodi
The document discusses influencing, motivating, and leading knowledge workers. It defines knowledge workers as highly educated employees who contribute through specialized knowledge rather than manual labor. While knowledge workers are increasingly seen as the main source of competitive advantage, organizations struggle to measure their value and understand how to empower them. The document argues that knowledge workers respond best to leadership that inspires trust, clarifies purpose, aligns systems to support goals, and unleashes talent through individual support and setting an example. An effective performance review system focuses on skills development rather than decisions about pay. Overall, organizations must transition to a new model that recognizes all employees, including so-called unskilled workers, as potential knowledge workers in order to fully benefit from their human
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The document discusses various aspects of justice in healthcare, including distributive, legal, and rights-based justice. It notes that distributive justice involves fair distribution of limited resources according to principles like need, effort, and merit. The document also discusses concepts like triage in emergency situations and debates around rationing healthcare resources. While many policies aim to consider efficiency and cost, ethical concerns also need to be addressed, such as ensuring access to life-saving care regardless of cost or ability to pay. Overall, the document examines different frameworks for justice in healthcare and debates around fairly allocating limited resources.
The document discusses several concepts related to justice in healthcare including distributive justice, legal justice, and rights-based justice. It notes that distributive justice concerns the fair distribution of limited healthcare resources according to principles like need, effort, and merit. Legal justice refers to applying legislation to protect victims and punish lawbreakers. Rights-based justice focuses on respecting individuals' rights rather than just applying law. The document also examines ethical challenges around rationing healthcare resources and prioritizing patients in situations with limited resources.
Historical factors that have influenced health care, Health ManagementArdavan Shahroodi
The document discusses five historical factors that have influenced how healthcare is delivered in the US: 1) The authority of the medical profession in organizing care, 2) Viewing healthcare as a market commodity, 3) Limited role of government in healthcare, 4) Influence of technology, and 5) Effect of medical malpractice litigation. It analyzes each factor in more depth, particularly the role of physicians in establishing standards and controlling financing mechanisms, and how this led to physicians operating as self-interested entrepreneurs and healthcare as a market-based system. The document also discusses the increasing but still limited role of government in healthcare financing and regulation.
County Hospital Director of Public Relations and Ethics.docxsdfghj21
The document discusses several ethical issues facing the Director of Public Relations and Ethics at County Hospital including abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating press release flyers outlining the hospital's position and rationale on each issue.
Project County Hospital Director of Public Relations and Ethics.docxwrite22
The document provides background information on ethical issues facing the director of public relations and ethics at County Hospital. It discusses five topics: abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating one-page press release flyers outlining the hospital's position on each issue.
There are several factors that influence how organ transplants are allocated. In the US, financial factors like insurance status and ability to pay play a role, while in the UK the National Health Service rationing explicitly limits certain expensive treatments. Both systems have benefits and weaknesses, and it can be argued that denying treatment is ethically easier in the UK system due to its explicit rationing. There is no consensus on the most ethical approach.
This document provides an ethical framework for analyzing public health dilemmas. It distinguishes three major philosophical approaches: utilitarianism, which is based on consequences and maximizing overall well-being; liberalism, which focuses on individual rights and opportunities; and communitarianism, which emphasizes virtue and the appropriate social order. The document explores each approach in depth and discusses how they relate to public health policy debates. It concludes that health professionals need enhanced skills in applied philosophy to improve policy deliberations on the inherent ethical issues in public health.
Healthcare Policy and Advocacy for Improving Population Health.pdfbkbk37
This document provides instructions for students to respond to two discussion posts by other students on the topic of the Affordable Care Act. Students are asked to analyze how cost-benefit analysis affected efforts to repeal/replace the ACA and how voter analysis may impact legislative decisions on policies like Medicare and Medicaid. Students must post an original discussion by day 3 and respond to two other students' posts with expansions or challenges to their explanations and examples.
EHR In Health Care Essay
Health Care Professionals Essay
Is Health Care a Right or a Privilege? Essay
Health Care Provider Essay
Essay on Quality Health Care
Healthcare in the United States Essay
The Cost Of Health Care Essay
Us vs Canada Health Essay
Managed Care Essay
Primary Health Care Essay examples
Health Care Essay
Essay On Health Care
The Problem Of Health Care Essay
Part IILaw and Ethics in Health Care AdministrationC.docxdanhaley45372
Part II
Law and Ethics in Health
Care Administration
Chapter 4
Patient Empowerment, Consent, and
Rights
Chapter 5
Privacy and Confidentiality
Chapter 6
Medical Mistakes and Patient Safety
Brand New Images/Iconica/Getty Images
The chapters in Part II deal with ethical issues regarding patients. Chapter 4 examines the patient empow-
erment movement and the importance of informed consent and patient rights. Chapter 5 delves into the
concepts of privacy and confidentiality as well as the legalities concerning the ethical notions of respecting a
person’s right to privacy and confidentiality. Chapter 6 discusses the ways in which ethical health care orga-
nizations address medical mistakes and examines the legal, regulatory, political, and administrative concerns
surrounding this issue, including protecting organizations from legal liability.
69
Associated Press/Brian Kersey
Patient Empowerment,
Consent, and Rights 4
Learning Objectives
1. Explore different forms of power in health care and their relevance to ethical organizational leadership.
2. Describe the patient empowerment movement.
3. Describe the history and importance of informed consent in ethical health care.
4. Critically analyze what informed consent requires of practitioners in health care contexts.
5. Articulate the benefits as well as the dangers of the consumer model in health care.
6. Explore whether and why health care is fundamentally different from commercial enterprises.
7. Investigate the patient bills of rights movement and the Affordable Care Act’s Patient’s Bill of Rights.
70
CHAPTER 4Section 4.1 Power in Health Care
In their influential study of more than 60,000 managers and other leaders, Jim Kouzes and Barry
Posner (2007) discovered a connection between people’s ability to achieve leadership and the fre-
quency with which they use the word “we” (p. 12). The dynamics of leadership demonstrate that,
when organized around clear principles and direction, a group of people can achieve goals that
would not only be beyond the ability of one person, but also beyond that of the same number of
people separately. This is the basic definition of synergy.
Synergy can also be applied to the health care professional-patient relationship. When patients
collaborate with their providers to achieve agreed-upon goals, they enjoy higher satisfaction with
their care and benefit from better outcomes (Hibbard & Greene, 2013). Patients who feel power-
less in their provider-patient relationship tend to respond defensively, even taking an adversarial
stance, and are often deemed “noncompliant” (Becker, 1985, p. 539) by health care professionals.
The ethical leader will want to distribute power evenly between the caregiver and patient in order
to achieve better results and facilitate healing. From a managerial perspective, studies show that
leaders who distribute power throughout the organization increase the cooperation of mem-
bers (Fuller, Morrison, .
CHAPTER 7The policy processEileen T. O’GradyThere are tJinElias52
CHAPTER 7
The policy process
Eileen T. O’Grady
“There are three critical ingredients to democratic renewal and progressive change in America: good public policy, grassroots organizing and electoral politics.”
Paul Wellstone
Nurses can more strategically and effectively influence policy if they have a clear understanding of the policymaking process. Conceptual models can help to organize and interpret information by depicting complex ideas in a simplified form; to this end, political scientists have developed a number of conceptual models to explain the highly dynamic process of policymaking. This chapter reviews two of these conceptual models.
Health policy and politics
Health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health and health care (see Box 7.1 for policy definitions). A clear understanding of the points of influence to shape policy is essential and includes framing the problem itself. For example, if nurses working in a nurse-managed clinic are troubled by staff shortages or long patient waits, they may be inclined to see themselves as the solution by working longer hours and seeing more patients. Defining and framing the problem is the first step in the policy process and involves assessing its history, patterns of impact, resource allocation, and community needs. Broadening and framing the problem to influence or educate stakeholders at the local, state, or federal level could include advocating for better access or funding for nursing workforce development (see Box 7.1).
BOX 7.1
Policy Definitions
Policy is authoritative decision making related to choices about goals and priorities of the policymaking body. In general, policies are constructed as a set of regulations (public policy), practice standards (workplace), governance mandates (organizations), ethical behavior (research), and ordinances (communities) that direct individuals, groups, organizations, and systems toward the desired behaviors and goals.
Health policy is the authoritative decisions made in the legislative, judicial, and executive branches of government that are intended to direct or influence the actions, behaviors, and decisions of others (Longest, 2016).
Policy analysis is the investigation of an issue including the background, purpose, content, and effects of various options within a policy context and their relevant social, economic, and political factors (Dye, 2016).
The next step is to bring the problem to the attention of those who have the power to implement a solution. Other key factors to consider include generating public interest, the availability of viable policy solutions, the likelihood that the policy will serve most of the people at risk in a fair and equitable fashion, and consideration of the organizational, community, societal, and political viability of the policy solution.
Public interest is a fascinating dynamic ...
This document discusses procedural justice in resource allocation decisions in healthcare. It presents two case studies from Oregon regarding different approaches to allocating scarce healthcare resources: 1) Allocation by expert panels, which led to public outcry over denied benefits, and 2) Allocation by community consensus, where Oregon engaged the public to articulate healthcare values and priorities. The document emphasizes that just processes are needed for ethical resource rationing and that solely relying on healthcare experts may not be sufficient - democratic deliberation involving affected communities is also important to develop policies with moral legitimacy.
The student writes a letter to an honorable Simon bringing attention to the pressing issue of rising healthcare costs among elderly Hispanic Americans in the region. This is impacting individuals' health and families' financial stability as well as the overall economy. The student urges the honorable Simon to take action by prioritizing policies that improve healthcare affordability, access, and equity for this group. Addressing the issue could significantly reduce costs for healthcare organizations and taxpayers while improving individuals' health outcomes.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
Review pages 109–110 of Essentials of Health Policy and Law as wel.docxjoellemurphey
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Examination and Treatment for Emergency Medical Conditions and Women in Labor
You are a consultant specializing in policy analysis. Based on theExamination and Treatment for Emergency Medical Conditions and Women in Labor legislation, as well as the situation that follows, you will complete a policy analysis with 3–5 options for your client, Congresswoman Moody, to consider.
Congresswoman Moody represents a state that borders Mexico. She is up for re election next year, and she will seek another term in office.
There are many undocumented workers that reside in her district. Congresswoman Moody is vocal about the need to provide health care to all that need it, but she also believes in fiscal restraint and does not support bail-outs for private facilities. She is well aware that her state’s Medicaid budget is almost exhausted for this year, and the state’s unemployment rate remains stubbornly high.
Apart from the voters, other affected constituents include three private regional medical centers trauma units that receive referrals from five or more small facilities that have emergency departments with lesser trauma status. Also, the largest health care corporation that owns two of the three medical centers in her catchment area, and which supported her in her last bid for election with campaign funds at the allowable limit, is threatening to refuse Medicare and Medicaid patients to ensure survival in the bad economy. An increase in unfunded mandates for urgent care may push this corporation into private payer only, and Congresswoman Moody is aware that there are enough affluent families in the area to support two facilities providing only designer medicine and concierge services.
All options must:
· Be within the power of Congresswoman Moody to do
· Be consistent with Congresswoman Moody’s values, and
· Address the issue identified in the problem statement
You will:
1. Identify 3–5 options for Congresswoman Moody’s consideration
2. Identify criteria that will be used to evaluate the options
3. Identify pros and cons for each option
4. Use a side-by-side table (MS® Excel® would be appropriate for this) to assist in analyzing the options.
Submitting Your Assignment
Prepare your written Assignment in a Word and/or Excel document and save it in a location and with a name you will remember, using the following naming convention: username-assignment-unit#.doc.
Page number 109
In terms of national constitutions, a 2004 survey reported that some two-thirds of constitutions worldwide address health or health care, and that almost all of these do so in universal terms, rather than being limited to certain populations.13 For example, consider the health-related constitutional aspects of four politically and culturally diverse countries—Italy, the Netherlands, South Africa, and Poland—that have some type of “right to health”: Italy’s Constitution guarantees a ...
This document contains discussion questions and assignments for an HCA 305 healthcare administration course. It includes questions about factors that impact healthcare expenditures in the US and how US healthcare spending compares to other countries. It also addresses healthcare reform, quality improvement in hospitals, choosing healthcare providers, and the Patient Protection and Affordable Care Act. Students are asked to discuss, analyze, and provide opinions on these healthcare administration topics.
The Role of Government in the U.S. Health Care SystemAs stated in .docxsuzannewarch
The document discusses the role of government in the U.S. health care system. It notes that while health care is an important part of the social and economic systems, the current system is viewed as broken with millions uninsured and rising costs. There is debate around the proper role of government in health care, with disagreement on how best to address issues in a polarized political environment. Students are asked to consider whether health care is a right or privilege, and examine how a social, economic, technological, ethical, or legal issue impacts delivery and if it should be addressed publicly or privately.
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The Control of Payments to Physicians, version 2
1. Running Head: The Control of Payments to Physicians 1
The Management and Control of Payments to Physician
Week # 2 Written Assignment
Ardavan A. Shahroodi
Northeastern University
Professor James J. Ferriter
HMG6110-The Organization, Administration, financing and history of Healthcare in the U.S.
April 19, 2013
2. The Control of PaymentstoPhysicians
Introduction
The question of a moratorium on payments to physicians whether for Medicare related
services or other health insurance matters is an emotionally charged issue. Many physicians
would passionately and sincerely argue that such wage and price controls are an infringement on
their inherent and constitutional right to charge a fee based on what is supported by the market
for the rendering of their services. As Dr. R. M. Sade (1971) stated, “Medical care is neither a
right nor a privilege: it is a service that is provided by doctors and others to people who wish to
purchase it” (as cited by Barr, 2011, p. 15).
On the other hand, those who finance and pay for physicians’ services may contend that
for very legitimate reasons, the U.S. health care market in the contemporary era is unlike a
classical exchange of goods and services were supply and demand forces are in charge of price
fluctuations. These voices would emphasize that the health care market and related prices in this
economy are heavily influenced by government subsidies, the process of political consensus
building among stake holders and as Douglass North (1986) would argue our “institutional
forces” (as cited by Barr, 2011, p. 123). They also add that the cumulative synergic influence of
these forces have led to a creation of an economic environment were price escalation is an
endemic characteristic of the system thereby negating the notion of the free exchange of goods
and services.
In light of the above arguments, how can we produce equitable and sustainable strategies
that would deal competently and effectively with the issue of cost controls in the health care
field? The practice of managing the level or for that matter increase of payments to physicians is
an example of such aforementioned cost controls. Here, we must investigate the factors that
3. The Control of PaymentstoPhysicians
either directly or indirectly influence the price of a physician’s services. These factors are moral,
ethical, political and economic.
The Moral/Ethical Dimension
The Love for Liberty
In order to analyze the moral and ethical factors that affect the price of a physician’s
services it is important to remember that in the U.S., governmental intrusion in commercial
activity is seen as essentially morally undesirable due to the level of dependency that it will
generate in the general public. As much as, in the modern era (approximately from the
beginning of the 20th Century) government has gradually increased her role in American life, the
18th and 19th Centuries were witness to a very limited role for the central authority except for
national security matters. There exists a strong imperative in the American lore that considers
self- sufficiency, entrepreneurship and independence in almost mythical and mystical terms.
This is a land that was created by those fleeing from persecution at the hands of European landed
aristocracies and that very notion and method of acquiring privilege is anathema to the American
character (in spite of the current popular infatuation with royalty). Consequently, the image of
the self-sufficient individual creating destiny through personal effort is one of the pillars of the
American civilization.
We also have to realize that the aforementioned nature of the American psychology is
steeped deeply in the historical legacy of those European skilled tradespeople and artisans who
liberated themselves from the yoke of classes of titled nobility thereby hoping to create a society
where individuals are rewarded on the basis of their innate merit and ability. In such a society
one is allowed to create opportunity based on one’s own effort, determination and zeal. This is
4. The Control of PaymentstoPhysicians
what is referred to as liberty and any effort to curtail and hinder such an expression of an
individual’s right to better oneself through personal effort is generally deemed as immoral. Very
few other expressions of the American identity have left such an indelible effect on what we
aspire to be and create in our institutions as promoting liberty and possessing the unhindered
freedom of exercising our trade. This is precisely why placing outside controls on payments is
understood and interpreted as unnatural, unfair and immoral by a large number of the physician
community in this country. Any solution that is created in order to address the issue of
escalating physician payments must be fully cognizant of the above imperative as what Douglass
North (1986) would refer to as an enduring American “institution” (as cited in Barr, 2011, p. 51).
The Passion for Seeking Fairness/Equity
A second moral and ethical dimension of the issue of controlling payments to physicians
is the question of fairness and equity. As the previous discussion in the moral sphere was
developed, we investigated the historical emergence of the idea of liberty as an institutional force
in the American character, life and society. That is the idea of having the freedom to better our
life and the life of our loved ones through one’s own effort unhindered by restrictions and
encumbrances. This premise is also supported by a further narrative promoting equity and
fairness in human relations. Here the question always reverts back to, “What is fair?” and “What
is equitable?” Indeed, is it fair to subject those who have placed exceptional effort in acquiring a
set of skills (physicians) that are immensely valued by our society to wage and price controls by
restricting payments for their services that were delivered conscientiously and sincerely? Here,
with respect to physicians the more arbitrary and non-integrative the process of payment controls
the more alienated this category of health care providers will become from any solutions that
would be proposed as a cost saving measure.
5. The Control of PaymentstoPhysicians
The Urge for Volunteerism
The third aspect of the moral and ethical analysis of payment controls to physicians is the
impetus for volunteerism in American society. The concept of volunteerism is also rooted in the
idea of liberty. Whereas in a controlled society one is mandated by the higher authority to
perform an act, in a society organized on the principle of liberty, we are moved singularly by our
conscience and personal standards to engage in all conduct be it steeped in empathy for others or
for that matter parting ways with one’s justly earned income. A reflection of this sentiment is
Dr. Abell’s (1938) statement that “The medical profession by principle and tradition is
committed to the idea that the prime object, the standard of value and the social reason for its
existence are all one thing—the service it can render to humanity” (as cited in Barr, 2011, p. 17).
Dr. Abell (1938) also exhorts his fellow physicians to remember that “the fundamental tenet of
the American Medical association that the poverty of a patient should demand the gratuitous
service of a physician” (as cited in Barr, 2011, p. 17). Here, allow us to take note that the
emphasis in the above statements is on two voluntary concepts rooted in personal and communal
(the medical community) world views namely principle and tradition. Dr. Abell (1938) is
arguing that as doctors, our central mission is to serve human kind and as such that particular
category of patients who are less fortunate than others (as cited in Barr, 2011, p. 17). However,
Dr. Abell (1938) is also contending that we are moved to the aforementioned pattern of behavior
due to our own beliefs, our own traditions and because of whom we are and not in response to
pressures and demands from outside forces and interests.
Consequently, any solution that is meant to address the nature and amount of
compensation to physicians must also take into consideration the affinity towards volunteerism
that is inherent in the American character. That is, as long as we are mandating and
6. The Control of PaymentstoPhysicians
commanding wage and price controls (payments to physicians) independent of the voice of
physicians in setting these limitations we will be involved in a distributive process where any
measure limiting their justly earned income is viewed as not in line with the much valued spirit
of volunteerism embedded within the parameters of the American personality.
Our discussion on the ethical and moral criteria that may be fulfilled in our path towards
creating enduring and sustainable solutions in controlling payment to physicians propose three
fundamental principles of the American character. These overarching principles are the
indispensable love for liberty, the passion for seeking fairness/equity and the urge for
volunteerism. All three of these principles must be present in one way or the other in the
finalized strategy that will be aimed at controlling payment to physicians.
Liberty, fairness/equity and volunteerism as institutions in American Society
Liberty, fairness/equity and volunteerism as organizing ethical and moral principles are
what North (1986) would call the “institutions” (as cited in Barr, 2011, p. 51) of the American
society. In this regard, Scott (1987) has proposed that the characteristics of institutions are
identified by the “…rules that guide behavior in certain situations…rules can be formal or
informal…over time, those rules come to be taken largely for granted …disobeying the rules will
invoke some sort of sanction, either formal or informal” (as cited in Barr, 2011, p. 53). Here
North (1986) adds that institutions “are not necessarily or even usually created to be socially
efficient” (as cited by Barr, 2011, p. 52). As a result, the organizing institutional identity of the
American society namely the ethical and moral imperatives erring on behalf of liberty,
fairness/equity and volunteerism must be fulfilled in any attempt to come to terms with
addressing the issue of unmanageable escalating compensation to physicians. Here, we may
conclude with the observation of Victor Fuchs (2010) that the rising of health care costs may not
7. The Control of PaymentstoPhysicians
be controlled through market forces alone rather a combination of “government regulation and
self-regulation [of the medical profession] through professional ethics” (as cited in Barr, 2011, p.
19). The self-regulation and professional ethics that Fuchs (2010) is referring to are part and
parcel of the principles/institutions of liberty, fairness/equity and volunteerism (as cited in Barr,
2011, p. 19) that must be present in any strategy that is to be created in order to manage
physician compensation.
The Political Dimension
On the basis of the ethical and moral principles/institutions of liberty, fairness/equity and
volunteerism we may create politically workable and sustainable solutions in pursuit of our goal
of managing physician compensation. One such instrument may already be in the process of
being developed and lunched since the Affordable Care Act (ACA) will create a vehicle named
the “Independent Payment Advisory Board (IPAB) made up of fifteen members appointed by the
president and confirmed by the Senate” (Barr, 2011, p. 163) whose mandate will be to address
“the broader issue of the rising cost of Medicare over time” (Ibid). Here, “Beginning in 2014, if
it turns out that projected per beneficiary spending will exceed the target amount, IPAB is
charged with the responsibility of coming up with a plan to rein in spending to meet the target
amount” (Barr, 2011, p. 164). Nevertheless, IPAB will not have the authority to raise taxes,
restrict benefits to beneficiaries in any manner or form as a means of controlling the escalating
cost of Medicare or “increase Medicare beneficiary cost sharing” (deductible, co-payments)
(Barr, 2011, p. 164). IPAB’s generated plan for controlling the cost of Medicare will be
implemented by the secretary of human and health services unless Congress creates her own
plan. The rubric for the IPAB is “tied initially to the growth in the consumer price index (a
8. The Control of PaymentstoPhysicians
general measure of price inflation) and subsequently to the overall growth in GDP” (Barr, 2011,
p. 163).
IPAB will be dealing with a cost related, financial and ultimately economic issue of
managing the escalating expense of Medicare, however IPAB is essentially a political vehicle
created in order to address a political matter. Here, allow us to refer once again to the
institutions of liberty, fairness/equity and volunteerism as fundamental organizing principles in
the functioning of the American polity. Precisely because of these aforementioned institutions,
the American system of government is based and rooted on governance on the consent of the
governed. Inherent, in this consent is the political process of consensus building among multiple
actors and stake holder. Furthermore, consensus building is a cumbersome, arduous and at times
mind numbing exercise, nevertheless this is the manner by which our system of government
acquires its very legitimacy to govern and as a matter of fact to govern effectively. Authentic
democracy is a time consuming practice of forging integrative solutions in order to address
concerns of the people.
In this spirit, a well-represented, diversified, inclusive and independent IPAB will be able
to consider the interests of all the stake holders (beneficiaries, physicians, health care oriented
actors, industry, and other tax payers) and generate plans that would represent the concerns of all
the involved parties. In addition, it is most important that IPAB maintain its non- revenue raising
and non- benefits influencing status so that it may singularly focus on the mandate of managing
“Medicare’s per beneficiary spending increases” (Barr, 2011, p. 163) based on the instrument of
the consumer price index. This one characteristic of the IPAB will allow political credibility and
legitimacy to be created for their mission and conduct independent of the intensely partisan and
emotional issues related to taxation and “rationing” (Barr, 2011, p. 164) of health care benefits
9. The Control of PaymentstoPhysicians
for beneficiaries. The question of managing the escalation of payments to physicians is also an
aspect of the “Medicare’s per beneficiary spending increases” (Barr, 2011, p. 163) that will be
addressed by the IPAB utilizing the aforementioned consumer price index and other
financial/economic vehicles such as the “sustainable growth rate” (SGR) (Barr, 2011, p. 158),
“resource based relative value scale” (RBRVS) (p. 142) and the “relative value unit” (RVU)
(Ibid). SGR, RBRVS and RVU are discussed in the following section on the economic factors
that must be present in order to create sustainable solutions for managing escalating payments to
physicians.
The Economic Dimension
The economic/financial factors that must be present in order to create workable and
sustainable solutions to the question of managing escalating payments to physicians are already
available to policy makers. The Medicare related “resource based relative value system”
(RBRVS) (Barr, 2011, p. 142) created by Congress is a method of “measuring the resources that
go into the provision of a medical service and assigning a value reflecting those resources”
(Ibid). This value assigning system is based on attaching “RVUs [relative value units] according
to the resources required to perform the procedure” (Barr, 2011, p. 142). The cumulative effect
of the existence of RBRVS and its associated RVUs is the adoption of the “sustainable growth
rate” (SGR) created by Congress in order to manage payments to physicians. SGR establishes an
“expenditure target based on current year expenditures” (Barr, 2011, p. 158) in order to
determine the level of payments “for physician care under Part B of Medicare” (Ibid). This
target is adjusted yearly based on inflation, number of beneficiaries, growth rate of GDP per
capita and new legislation effecting Medicare Part B (Barr, 2011, p. 159). The earlier mentioned
Independent Payment Advisory Board (IPAB) will be the autonomous political vehicle that
10. The Control of PaymentstoPhysicians
would be ideal for the adoption and implementation of the SGR in managing the escalation of
payments to physicians.
Conclusion
In order to constructively and effectively manage the level of payments to physicians in
Medicare or other insurance related matters, we need to create solutions that are cognizant of the
moral/ethical, political and economic/financial aspects of the mission at hand. Any generated
outcome in this pursuit must indeed possess all the aforementioned ingredients in order to remain
sustainable over an extended period of time. Nevertheless, it is the contention of this paper that
among all the proposed ingredients, it is the moral/ethical imperative that will act as the central
element in the ultimate success or failure of the goal of controlling the level of payments to
physicians. In the final analysis, all questions are settled in relation to their moral/ethical worth
and all other matters are merely peripheral.
11. The Control of PaymentstoPhysicians
References
Barr, D. A. (2011). Introduction to U.S. Health Policy: The organization, financing, and
delivery of health care in America (3rd ed.). Baltimore, MD: The Johns Hopkins
University Press.
Fuchs, V. R. (2010). Health care is different—that’s why expenditures matter. JAMA 303:
1859-60.
North, D. C. (1986). Institutions, institutional change and economic performance. New York,
NY: Cambridge University Press.
Sade, R. M. (1971). Medical care as a right: A refutation. New England Journal of Medicine
285:1288-92.
Scott, W. R. (1987). The adolescence of institutional theory. Administrative Science Quarterly
32: 493-511.