Cost of Health Care    

Read: Prior to beginning this discussion, read Chapter 1 and Chapter 3 of your textbook along with the article “Mental  health clinician attitudes to the provision of preventive care for  chronic disease risk behaviours and association with care provision.”

Reflect: Health Care Reform has, for a long time,  been a hot topic. Costs of Medicare, loss of jobs, increased costs of  doing business, are all part of the problem/need. Consider the two  citations below:

We have invented more health care than we can afford to deliver….We  already ration. The United States denies more health care to more people  than any other developed country in the world. We did that by leaving  50 million people out of the system (before the Affordable Care Act).

[For example] I don’t believe you should give any extensive  operations to anybody over 85. You should make sure that they’re clean,  they’re loved, they’re comfortable, they’re pain-free, but we shouldn’t  be doing high-technology medicine on people over 85. (Lamm, 2015)

A rising proportion of medical expenditure is now devoted to  prolonging the lives of the very old and the terminally ill. The costs  of this are potentially unlimited.
 

We should pause to ask  ourselves the questions raised by the surgeon Atul Gawande in his book,  Being Mortal. Perhaps the greatest challenges in modern healthcare are  not those of meeting the spiraling cost of advanced medical  technologies. They lie in accepting that we are all going to die, and  learning to do so with dignity.

Efforts at cost containment and the rationing of medical services are  impinging deeply on the elderly and placing physicians in roles that  may interfere with the covenant of faithfulness that exists between  physician and patient. Physicians must examine negative societal images  that may influence the care of the elderly and hold firm to the  commitment to respond to the needs, values, and best interests of the  elderly in the face of changing health care policies and constraints of  one kind or another. Further, a major ethical imperative for physicians  relates to making themselves available for the treatment of the elderly  in the context of an appreciation of these patients’ tasks in the final  stage of development.

Write: As an assistant in arranging discharge  planning with a social worker and a multi-disciplinary team,  you are  asked for your professional input as an elderly woman living alone is  being discharged to a long term facility. A high risk procedure and  expensive procedure is being suggested for this 87 year old woman. The  issue of cost for such procedures for the elderly has surfaced among the  team. The team is discussing the decision of the procedure and social  services is consulted for a full consideration of the patient in her  context.

Utilizing what you have learned in the program and including extra resources, address the following: Evaluate the value assumptions that influence your recommendation. Describe how you would respond to these values as you self-reflect. Describe how much cost of the procedure would influence your recommendation. Should you consider what your client wants? How does this weight against professional values and opinions? Explain your recommendations to the team.

Guided Response: In responding to your classmates,  are you in agreement with the values they proposed? What input would you  give to the treatment team based on their recommendations? Would you  suggest a different perspective? If so, describe your perspective and  why you would suggest this as a fellow team member.