Financing of Health Care

With coinciding concerns about health care costs and the imperativeto improve quality of care, health care providers and others facedifficult decisions in the effort to achieve an appropriate balance.Such decisions often are addressed in the policy arena. How dopolicymakers evaluate which health care services should be financedthrough government programs? How do ethics-related questions and otherconsiderations play into this evaluation process? Is it possible tocontain costs and provide accessible, high-quality care to all, or isthe tension between cost and care inherent in the U.S. health caredelivery system? These questions are central to health care financingdecisions in the United States.

For this Discussion, you will focus on the policy decision-makingprocess that determines what types of care are covered by public andprivate insurers and the ethical aspects of such financial decisions.

To prepare:

• Read the following case study, “Hard Economic and Finance Choices in US Healthcare” (Milstead):
  • Case Study 1: Hard Economic and Finance Choices in US Healthcare
    Appliedeconomics is all about managing scarce resources. Economics is anamoral field of study: it is neither moral nor immoral. Morality andvalues are determined by individuals at the personal level and by groupconsensus or majority opinion at the national level. State and federalgovernments determine the ‘will of the people’ about how to use scarceresources for the good of a nation.

    The U.S. health caresystem is an exemplar of scarcity: primary care physicians, substanceabuse treatment centers, trauma centers, registered nurses, and themoney to pay for goods and services. Finance is all about how to pay forgoods and services. The Medicare Payment Advisory Commission (MedPAC)is appointed by the Executive branch of the federal government to makedecisions about what the Medicare program will and will not pay for. Inthis role, MedPAC makes decisions about medications, procedures andtreatments. Examples of MedPAC decisions include coverage for leftventricular assistive devices as a destination therapy, coverage forbariatric surgery, and in 2010, coverage of the drug Provenge™. By law,MedPAC is not allowed to use price or cost of any treatment in itsdecision-making processes.

• Review the information in the Washington Post article “Review ofProstate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” inthe Learning Resources.
• Consider how policy decisions currently are made about what willand will not be paid for and what changes, if any, could improve theprocess.
• Reflect on how the Washington Post example illustrates the tension between cost and care. References:
  National Health Expenditures 2010 Highlights, Centers for Medicare & Medicaid Services (n.d.). Retrieved from https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf.Milstead, J. A. (2013). Health policy and politics: A nurse's guide (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.Write your analysis and assessment of the ethical and economic challenges relatedto policy decisions such as those presented in the Washington Postarticle. How does this type of situation contribute to the tension between costand care? Substantiate your response with at least two outside resources. Use the following headings to answer the question:
  Healthcare FinancingAnalysisand Assessment of Ethical and Economic Challenges Presented in Washington PostHowThis Situations Affects Cost and Care