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Lu A, Ji RZ, Ge AY, Ross JS, Ramachandran R, Redberg RF, Dhruva SS. Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices. JAMA 2023; 330:1094-1096. [PMID: 37589985 PMCID: PMC10436180 DOI: 10.1001/jama.2023.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
This study reviewed public comments for all Medicare National Coverage Determinations between June 2019 and 2022 on select pulmonary and cardiac devices to determine whether financial conflicts of interest were disclosed.
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Affiliation(s)
- Angela Lu
- School of Medicine, University of California, San Francisco
| | - Robin Z. Ji
- Department of Medicine, University of California, San Francisco School of Medicine
| | - Alex Y. Ge
- School of Medicine, University of California, San Francisco
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Reshma Ramachandran
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rita F. Redberg
- Department of Medicine, University of California, San Francisco School of Medicine
| | - Sanket S. Dhruva
- Department of Medicine, University of California, San Francisco School of Medicine
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Milliken A, Jurchak M, Sadovnikoff N. When Societal Structural Issues Become Patient Problems: The Role of Clinical Ethics Consultation. Hastings Cent Rep 2019; 48:7-9. [PMID: 30311206 DOI: 10.1002/hast.894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The debate about health insurance coverage and the related issue of unequal access to health care turn on fundamental questions of justice, but for an individual patient like DM, the abstract question about who is deserving of health insurance becomes a very concrete problem that has a profound impact on care and livelihood. DM's circumstances left him stuck in the hospital. A satisfactory discharge plan remained elusive; his insurance coverage severely limited the number and type of facilities that would accept him; and his inadequate engagement in his own rehabilitation process limited discharge options even further. Despite extensive involvement with the psychiatry, social work, physical therapy, and occupational therapy teams, DM consistently made "bad" decisions. He repeatedly refused antibiotics and did not consistently work with rehab services to improve his strength and mobility. Although the clinicians wanted to provide him with the best care possible, he often seemed unwilling to do the things necessary to achieve this care-or perhaps his depression rendered him unable to do so. He also tended to take out his frustration on staff members caring for him. All of this was, in turn, very frustrating for the staff. It may be easy, however, to make too much of DM's role, to see his choices as more important than his circumstances. A major goal of the ethics consultants was to reframe DM's predicament for the staff members involved in his care.
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Abstract
Because the United States has failed to provide a pathway to citizenship for its long-term undocumented population, clinical ethicists have more than 20 years of addressing issues that arise in caring for this population. I illustrate that these challenges fall into two sets of issues. First-generation issues involve finding ethical ways to treat and discharge patients who are uninsured and ineligible for safety-net resources. More recently, ethicists have been invited to help address second-generation issues that involve facilitating the presentation for care of undocumented patients. In the current environment of widespread fear of deportation in the immigrant community, ethicists are working with health care providers to address patient concerns that prevent them from seeking care. I illustrate that in both generations of issues, values implicit within health care, namely, caring, efficiency, and promotion of public health, guide the strategies that are acceptable and recommended.
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Abstract
Disparities in access to infertility care and insurance coverage of infertility treatment represent marked injustices in US health care. The World Health Organization defines infertility as a disease. Infertility has multiple associated billing codes in use, as determined by the International Statistical Classification of Diseases and Related Health Problems. However, the often-prohibitive costs associated with infertility treatment, coupled with the lack of universal insurance coverage mandates, contribute to health care inequity, particularly along racial and socioeconomic lines.
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Affiliation(s)
- Iris G Insogna
- A reproductive endocrinology and infertility fellow at Brigham and Women's Hospital in Boston, Massachusetts
| | - Elizabeth S Ginsburg
- A professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and the medical director of the Assisted Reproductive Technologies Program at Brigham and Women's Hospital in Boston, Massachusetts; and a member of the ethics committee of the American Society for Reproductive Medicine
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Ramke J, Gilbert CE, Lee AC, Ackland P, Limburg H, Foster A. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage. PLoS One 2017; 12:e0172342. [PMID: 28249047 PMCID: PMC5382971 DOI: 10.1371/journal.pone.0172342] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). METHODS All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. FINDINGS Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%), CSOGood was 58.9% (IQR 53.7-67.6%) and CSOPoor was 17.7% (IQR 11.3-21.1%). Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1%) than for CSC (median 2.3% IQR -1.5-11.6%). CONCLUSION eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.
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Affiliation(s)
- Jacqueline Ramke
- School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Clare E. Gilbert
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arier C. Lee
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Ackland
- International Agency for the Prevention of Blindness, London, United Kingdom
| | - Hans Limburg
- Health Information Services, Nijenburg 32, Grootebroek, Netherlands
| | - Allen Foster
- Department Clinical Research, Faculty Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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MESH Headings
- Attitude of Health Personnel
- Clinical Competence
- Combined Modality Therapy/economics
- Combined Modality Therapy/trends
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/therapy
- Electronic Health Records/economics
- Electronic Health Records/trends
- Health Care Costs/ethics
- Health Care Costs/trends
- Humans
- Insurance Coverage/economics
- Insurance Coverage/ethics
- Insurance Coverage/trends
- Insurance, Health/economics
- Insurance, Health/ethics
- Insurance, Health/trends
- Medicare/economics
- Medicare/ethics
- Medicare/trends
- Peer Review, Health Care/ethics
- Peer Review, Health Care/trends
- Precision Medicine/economics
- Precision Medicine/trends
- Prejudice/psychology
- Quality of Health Care/economics
- Quality of Health Care/standards
- Quality of Health Care/trends
- Stress, Psychological/etiology
- Stress, Psychological/psychology
- United States
- Workforce
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Affiliation(s)
- Irl B Hirsch
- University of Washington School of Medicine , Seattle, Washington
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Field RI. The Ethics of Expanding Health Coverage through the Private Market. AMA J Ethics 2015; 17:665-671. [PMID: 26158815 DOI: 10.1001/journalofethics.2015.17.7.msoc1-1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Robert I Field
- Professor of law at the Thomas R. Kline School of Law and a professor of health management and policy at the School of Public Health at Drexel University in Philadelphia, and a lecturer in health care management in the Wharton School and a senior fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and writes and edits the Field Clinic blog for the Philadelphia Inquirer, and is the author of Health Care Regulation in America: Complexity Confrontation and Compromise (Oxford University Press, 2007) and Mother of Invention: How the Government Created Free-Market Health Care (Oxford University Press, 2013)
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Affiliation(s)
- Steven G Ullmann
- Director of the Center for Health Sector Management and Policy and a professor in the School of Business Administration at the University of Miami, Florida
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Galarneau C. Health Care Sharing Ministries and Their Exemption From the Individual Mandate of the Affordable Care Act. J Bioeth Inq 2015; 12:269-282. [PMID: 25672616 DOI: 10.1007/s11673-015-9610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/23/2014] [Indexed: 06/04/2023]
Abstract
The U.S. 2010 Patient Protection and Affordable Care Act (ACA) exempts members of health care sharing ministries (HCSMs) from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption's less than clear legislative justification, their potential influence on the ACA's policy and ethical success, and their salience to current religious liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States' three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: (1) the charity versus insurance status of these ministries; (2) the conflation of two ACA religious exemptions; (3) the tension between the values of religious liberty and of justice; (4) the potential undermining of ACA policy goals; and (5) the questionable compliance of health care sharing ministries with ACA exemption requirements. An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here.
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Affiliation(s)
- Charlene Galarneau
- Women's and Gender Studies Department, Wellesley College, 106 Central Street, Wellesley, MA, 02481, USA,
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12
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Holwager D. HIP 2.0: Plan Limitations Lead to Ethical Dilemmas. J Indiana Dent Assoc 2015; 94:24-26. [PMID: 26817048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Sonfield A. Religious exemptions in insurance coverage and the patient-clinician relationship. Virtual Mentor 2014; 16:864-869. [PMID: 25397644 DOI: 10.1001/virtualmentor.2014.16.11.spec1-1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Adam Sonfield
- Senior public policy associate at the Guttmacher Institute in Washington, DC, and the executive editor and a regular contributor to its journal, the Guttmacher Policy Review
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Abstract
A psychiatric diagnosis today is asked to serve many functions-clinical, research, medicolegal, delimiting insurance coverage, service planning, defining eligibility for state benefits (eg, for unemployment or disability), as well as providing rallying points for pressure groups and charities. These contexts require different notions of diagnosis to tackle the particular problem such a designation is meant to solve. In a number of instances, a 'status' definition (ie, a diagnostic label or category) is employed to tackle what is more appropriately seen as requiring a 'functional' approach (ie, how well the person is able to meet the demands of a test of performance requiring certain capabilities, aptitudes or skills). In these instances, a diagnosis may play only a subsidiary role. Some examples are discussed: the criteria for involuntary treatment; the determination of criminal responsibility; and, assessing entitlements to state benefits. I suggest that the distinction between 'status' versus 'function' has not been given sufficient weight in discussions of diagnosis. It is in the functional domain that some of the problematic relationships between clinical psychiatry and the social institutions with which it rubs shoulders are played out. A status, signified by a diagnosis, has often been encumbered with demands for which it is poorly equipped. It is a reductive way of solving problems of management, allocation or disposal for which a functional approach should be given greater weight.
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Krakauer B, Agostini J, Krakauer R. Aetna's compassionate care program and end-of-life decisions. J Clin Ethics 2014; 25:131-134. [PMID: 24972063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article we describe the successes of Aetna's Compassionate Care Program in providing case management services for people with advanced illnesses.
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Affiliation(s)
- Barak Krakauer
- Department of Philosophy, University of California at Santa Cruz, 1156 High Street, Santa Cruz, CA 95064 USA.
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Meyer B. [Ethics and therapeutic advances in the field of prosthetics]. Soins 2013:52. [PMID: 24218925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Bertolt Meyer
- Université de Zurich, department of psychology, social and business psychology, Binzmuehlestrasse 14, Box 13, CH-8050 Zurich, Suisse.
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Bardey D, De Donder P. Genetic testing with primary prevention and moral hazard. J Health Econ 2013; 32:768-779. [PMID: 23771050 DOI: 10.1016/j.jhealeco.2013.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 03/07/2013] [Accepted: 04/24/2013] [Indexed: 06/02/2023]
Abstract
We develop a model where a genetic test reveals whether an individual has a low or high probability of developing a disease. Testing is not mandatory, but agents have to reveal their test results to the insurers, facing a discrimination risk. A costly prevention effort allows agents with a genetic predisposition to decrease their probability to develop the disease. We study the individual decisions to take the test and to undertake the prevention effort as a function of the effort cost and of its efficiency. If effort is observable by insurers, agents undertake the test only if the effort cost is neither too large nor too small. If the effort cost is not observable by insurers, moral hazard increases the value of the test if the effort cost is low. We offer several policy recommendations, from the optimal breadth of the tests to policies to do away with the discrimination risk.
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Affiliation(s)
- David Bardey
- University of Los Andes, Cede, Colombia; Toulouse School of Economics, France.
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Affiliation(s)
- Dana R Gossett
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Ste 1015, Chicago, IL 60611, USA.
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Affiliation(s)
- Eric A Zimmer
- Creighton University School of Medicine and Creighton Center for Health Policy Ethics, Omaha, Nebraska, USA
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Flynn C, Wilson RF. Institutional conscience and access to services: can we have both? Virtual Mentor 2013; 15:226-235. [PMID: 23472813 DOI: 10.1001/virtualmentor.2013.15.3.pfor1-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Cameron Flynn
- Washington and Lee University School of Law, Lexington, VA, USA
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23
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Kiefer B. [The Supra case, a thick fog and jamming]. Rev Med Suisse 2012; 8:2416. [PMID: 23346683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Smith W. Requirement to purchase health insurance. JAMA 2012; 308:1628-9; author reply 1629. [PMID: 23093157 DOI: 10.1001/jama.2012.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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25
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Nichols LM. Justice Roberts's health care stewardship. Hastings Cent Rep 2012; 42:17-8. [PMID: 22976406 DOI: 10.1002/hast.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sage WM. How many Justices does it take to change the U.S. health system? Only one, but it has to want to change. Hastings Cent Rep 2012; 42:27-33. [PMID: 22976410 DOI: 10.1002/hast.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Tina Rulli
- Department of Bioethics, NIH Clinical Center, Bethesda, MD 20892, USA
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Affiliation(s)
- Richard Smith
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
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Abstract
Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence.
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Affiliation(s)
- Nicolas Tavaglione
- Institut d’éthique biomédicale, Faculté deMédecine, CMU, 1 rue Michel-Servet, CH-1211 Genève 4, Geneva 1211, Switzerland.
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Parsi K, Hossa N. Complex discharges and undocumented patients: growing ethical concerns. J Clin Ethics 2012; 23:299-307. [PMID: 23469690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A growing number of discharges at acute-care hospitals involve patients who are undocumented and lack legal status. Because such patients are ineligible for public assistance, long-term care facilities will routinely deny them admission. These discharges become complex discharges because of such financial barriers. If local family support is unavailable, discharging such patients to a safe and suitable location becomes increasingly difficult. These complex discharges implicate a number of ethical principles. We describe such complex discharge cases, apply various ethical frameworks, and call for potential policy solutions to address this growing ethical concern.
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Affiliation(s)
- Kayhan Parsi
- Neiswanger Institute for Bioethics, Loyola University, Chicago Stritch School of Medicine, Maywood, Illinois, USA.
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Morreim H. Dodging the rules, ruling the dodgers. Am J Bioeth 2012; 12:1-3. [PMID: 22416739 DOI: 10.1080/15265161.2012.656801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.
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Abstract
U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for--as though health care is a commodity that needs no examination--or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with "health care," the terminology used in the current debate, but with the more modest and limited topic of medical care. Integral to this rationing proposal--which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society--is a definition of a "decent minimum," the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span.
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Affiliation(s)
- Lawrence J Schneiderman
- Family and Preventive Medicine and Medicine, University of California-San Diego School of Medicine, La Jolla, CA 92093, USA.
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Stark M. Shifting the focus of rationing discussions. Am J Bioeth 2011; 11:20-22. [PMID: 21745076 DOI: 10.1080/15265161.2011.578199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Meredith Stark
- Columbia University, 722 West 168th St., New York, NY 10032, USA.
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Mathur V. Ethical questions regarding health insurance in India. Indian J Med Ethics 2011; 8:23-27. [PMID: 22106594 DOI: 10.20529/ijme.2011.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Improved health and healthcare are of vital concern to the welfare of Indian society. The nascent health insurance system of the country is experiencing an explosive expansion and various models of health insurance provision are under trial by different agencies. Since the country has been relatively late in introducing health insurance, it can study the effects of different systems of healthcare and insurance and develop a system of health coverage which addresses the unique social character of our country as well as the ethical questions of comprehensiveness and inclusion. This article seeks to explore these issues in detail.
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Affiliation(s)
- Vineesh Mathur
- Orthopaedics, Medanta, The Medicity, Gurgaon 122 001 Haryana, India.
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Tietze U. [Difficult decision at bedside. Withholding treatment due to costs?]. MMW Fortschr Med 2010; 152:22. [PMID: 21319403 DOI: 10.1007/bf03367362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Penn CL. Code: complex. The complex physician-insurance relationship. J Ark Med Soc 2010; 107:80-82. [PMID: 20961021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
Many new cancer drugs provide only limited benefits, but at very great cost, for example, $200,000-$300,000 per quality-adjusted life year produced. By most standards of value or cost-effectiveness, this does not represent good value. I first review several of the causes of this value failure, including monopoly patents, prohibitions on Medicare's negotiating on drug prices, health insurance protecting patients from costs, and financial incentives of physicians to use these drugs. Besides value or cost-effectiveness, the other principal aim in health care resource allocation should be equity among the population served. I examine several equity considerations-priority to the worse off, aggregation and special priority to life extension, and the rule of rescue-and argue that none justifies greater priority for cancer treatment on the grounds of equity. Finally, I conclude by noting two recent policy changes that are in the wrong direction for achieving value in cancer care, and suggesting some small steps that could take us in the right direction.
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Affiliation(s)
- Dan W Brock
- Harvard Medical School, Boston, Massachusetts 02115, USA.
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Affiliation(s)
- Howard Brody
- Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, USA
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Sabik LM, Lie RK. Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts. Theor Med Bioeth 2008; 29:73-85. [PMID: 18535922 DOI: 10.1007/s11017-008-9062-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 05/01/2008] [Indexed: 05/26/2023]
Abstract
It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is "accountability for reasonableness." We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients' rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.
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Affiliation(s)
- Lindsay M Sabik
- Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA
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Wells JK. Ethical dilemma and resolution:a case scenario. Indian J Med Ethics 2007; 4:31-34. [PMID: 18630218 DOI: 10.20529/ijme.2007.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article illustrates an ethical dilemma that I faced while treating an 86-year-old woman at her home. The ethical dilemma was caused due to several factors such as the expectations of the client (client/consumer rights), organisational expectations (employer, governmental and payer-source regulations) and my own personal values (one's moral philosophies, perceived social responsibilities, sense of professional duty) and how they all interact with each other. The case is a classic example of a seemingly simple yet frequent dilemma encountered by occupational and physical therapists in the United States serving clients who are covered by Medicare (the government's health insurance) for home health. The article is aimed at highlighting the various ethical principles involved in clinical decision-making, and it suggests methods for resolution of ethical dilemmas. Although the article is based against the backdrop of the US health care system, students and health care practitioners globally can relate to it.
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Burkhard B. ["For the welfare of patients"--is this really the case?]. Versicherungsmedizin 2006; 58:181-6. [PMID: 17212301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
According to a decision by the German Federal Constitution Court (1 BvR 347/98), it is illegal to refuse compulsorily insured persons therapy if they suffering from a lifethreatening disease against which there is no effective therapy on the basis of current medical science. The chosen method of treatment should offer a not entirely remote chance of healing. What counts is the effect treatment has in each individual case. Serious objections to the the Court's criteria have been expressed by medical and legal experts, who contend that the Court has disregarded patients' protection against unknown risks and "quackery" as well as the incalculable financial effects on the community of insureds.
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Affiliation(s)
- B Burkhard
- Medizinischen Dienst der Krankenversicherung (MDK) in Bayern, München
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Teagarden JR, Wynia MK. Ensuring fairness in coverage decisions: Applying the American Medical Association Ethical Force Program’s consensus report to managed care pharmacy. Am J Health Syst Pharm 2006; 63:1749-54. [PMID: 16960260 DOI: 10.2146/ajhp050546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- J Russell Teagarden
- Clinical Practices & Therapeutics, Medco Health Solutions, Inc., 100 Parsons pond Drive, Franklin Lakes, NJ 07417, USA.
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Affiliation(s)
- Steven D Pearson
- Department of Clinical Bioethics, National Institutes of Health, Bethesda, Md 20892, USA.
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Keehan C. Those who don't receive medical care. Origins 2006; 36:81-5. [PMID: 16862726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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