Claudia Mills, one Pill Makes You Smarter: An Ethical Appraisal of the Rise of RitalinEssay Preview: Claudia Mills, one Pill Makes You Smarter: An Ethical Appraisal of the Rise of RitalinReport this essayAllen Buchanans article entitled “Managed Care: Rationing without Justice, But Not Unjustly” detailed on the most cited three ethical criticisms of management. Managed care is first and foremost, criticized to fail in discharging their obligations when it comes to improving access, or at least, not to worsen the already bad situation. Secondly, managed care organizations engage in rationing. This kind of practice prohibits patients to access care to which they are entitled. Lastly, managed care, as in pressures physicians to engage in rationing care, they affect physicians fulfillment of their fiduciary obligations to give the best care to each patient. However, Buchanan in this article, claimed that the three criticisms stem from misconceptions and misintepretation of the managed care institutions. The second and third criticisms assume incorrectly that the United States had already taken its first step in making sure there would be equitable access to care for all. They assume that there is already a standard level of care that must be achieved. And yet, these are not in existence yet. The criticisms did not recognize the fundamental flaw of managed care: the fact that managed care institutions operate in a setting in which there is no significant relationship between rationing activity and the basic requirements of justice.
The article by Allen Bunchanan could not be timelier. It was written more than a decade, but it could still be relevant to what is happening now, more than ever. The problem of managed care is highlighted everyday in different media forms. According to a New York Times article, the problem in the healthcare delivery has to do with what is happening in the economy. Workers who are unfortunate to lost their jobs suffered a double whammy. Not only did they lost their incomes, they lost their employer-based health insurance as a result as well. Millions are forced to let go of the medical care that they cannot pay more. When the people lost their jobs, they also find it hard to look for affordable coverage from insurance companies; some have their application rejected. Therefore, most of them would choose to go with managed care. Managed care is a health care program that is intended to reduce unnecessary costs of healthcare such as costs of care, inpatient admission costs, and inpatient surgery costs. In managed care, more emphasis is given to preventive care and early intervention or diagnosis instead of providing care after an illness or injury has occurred. The responsibility of limiting services is placed on the service provider rather than the patients. Usually they adopt some techniques such as contracting with health care providers, controlling impatient admissions and the length of hospital stay, giving incentives to physicians and patients to choose less costly forms of healthcare and more.
The thing is, it could be observed that what is actually happening is that medical care has been transformed into a commercialized form, a marketplace. Managed care involves a young reimbursement payment method, which could lead to some benefits and problems. Some of the problems comes from the insured customers. Specifically, some of them do not have the motivation nor the means to select their healthcare providers and services. With this inability, comes inflationary distortions in the purchasing system. Those who are unemployed would have no control of the negative consequences of this.
On the other hand, there are problems on the providers side as well. They provide insufficient incentives, which consist of irrational restrictions on payer and provider behavior, as manifested by the stringent insurance rules and bans on advertising. According to White, turning the managed care scenario into a marketplace, where market forces are harnessed could resolve some of these problems, because the forces could enhance the performance and preserve access ad choice. The rationale and effectiveness of managed care as a marketplace could be discerned in this paper, as well as the weaknesses of this phenomenon.
Although there are good selling points given to managed care, there are also some disadvantages of the program. Giving insurance companies more responsibility introduced new problems: incentives to under provide care, avoidance of high risk patients, coordination problems, and the risk of inflexibility in the provision of services. It appeared that there were several costs saving initiatives created by establishing managed care. Consumers making poor choices, lack of consumer incentives, providers overcharging, and providing competition to control health care costs were problems to be solved by managed care. Some managed care program also involves “risk contracts”. The risk contract, through a provider works this way: The managed care organization receives a certain amount of money from the payor (employer, Medicare, private individual) for each insured patient. For a specific number of patients, a certain amount is given to the physicians, another amount to the hospital. An agreement is settled and the providers agree to take care of these patients for the amount of money they receive. Losses are absorbed by the care providers if the costs to the providers are greater. However, if the costs to the providers are less, they keep the “excess” for profit.
Another disadvantage is that some HMOs dont adhere to their promised services. Services are limited based upon what the payor agrees to pay. Usually, the number of visits or the amount of money that will be paid for certain types of procedures are already outlined by the employers. Some complain that services are usually more limited in managed care. In terms of physician service, some provide therapists with less training than expected. At times, the assigned physicians are not accessible nor available at ones chosen time. Processing of appointments may take for some time.
Another disadvantage is that before a patient can be treated, a pre-approval must be presented, which puts a “hassle” to the patients concerned. Some concerned patients may have to change physicians because not all physicians participate in all managed care plans and some physicians take only a few of patients with a specific managed care organization. Because the managed care program has adopted a “selling” approach, some of the promised services have just become a “lip service”. (Managed care plan enrollees expect increased efficiency, improved overall standards, reduced costs and better quality of service. It appears that there is no consistent, direct correlation between the cost of care and its quality. Some critics have also observed that managed care has not been a successful health policy, because it has contributed to higher health care costs , such as higher overhead costs
, and may encourage an individual who has a higher need to be hospitalized to use the services while he stays in intensive care or even to return to work, as he may end up with less money. There are several points. First, managed care is not cost effective: The cost-effectiveness ratings have their limitations. The rates of care can vary. And the longer the care period, the lower the rate and thus the lower the rate, but as long as we pay some of the patients (usually, patients who have become less effective in their role at the hospital), we will continue to hear the same stories about how the system is going to change when care is no longer provided. Second, many of the patients who have given up managed care because of a higher cost, low cost of care or a lower quality of care have been hospitalized, often because of poor care that a hospital has received
Inpatient “’
to treat
Other issues
! In other words, care is being delivered. In a health care system this is not only fair and safe, but even possible. Third, at each and every one of these different systems, the costs of care often differ. For example, in some counties health care costs vary between state & country hospitals, even though the hospitals have different costs. It is clear from the way in which such different data is gathered on hospital care that the cost of care is almost invariably higher in those jurisdictions with primary state and state hospitals with other large and varied hospitals. Some state and even large regional health and disability system have higher cost of care
In order to provide some variation in results between hospitals
, some large regional system has adopted more expensive and less efficient care for more patients. This practice has lead to a lower cost of care that is increasing at all regional hospitals
, leading to higher numbers of fewer patients. (C.1130.2.4.13, “Medicare and the Care of Others.”) This practice has in effect caused the hospital to become worse-performing than it otherwise would have been. Thus patients are less likely to be discharged from the hospital. It is true that the number of beds in the system increases at a faster rate when more than 4 hours of care is provided. That might be true if at some point the hospital spends all of its hours with another hospital. However, in my experience the same could not be said of a whole-hospital hospital. The hospital has not changed, but the patient care process has. Medicare is the federal government’s plan to replace a system which is essentially a voucher system. Under the voucher system the federal government subsidizes nursing home care and hospital care. It pays the hospital care of the patient instead of the national hospitals. Under the voucher system the patient pays for the health care of the hospital itself. The hospital is then reimbursed for whatever it receives from the hospital. All of this goes to make many health care costs less. The same could not be said about hospitals in general as you said, but all hospitals have different policies with different results. When compared using the Medicare Medicare Advantage System, all the hospital costs are in the same place. It is not the case that Medicare in turn pays for most out-of-pocket hospital costs. At some hospitals the prices are a bargain. However, Medicare doesn’t pay hospital care. It pays to keep patients in the hospital so they can get better care. This is because the hospitals are not a service of the federal government. They are not the same thing as the private medical plan. The hospital’s profit motive