Ethical Challenges in Healthcare

Ethical Challenges in Healthcare

Introduction

Healthcare established in the current century operate under a complex web of rules and regulations that focus on the provision of quality and safe services to ensure quality patient outcome. One of these rules is the affordable care Act, whose intent is to increase access to insurance, ensure that patients achieve quality health services, strengthen consumer protections, and increase access to healthcare services. However, the ACA is associated with a couple of ethical challenges as health practitioners try to make the most even with strict restrictions. This paper will address the ACA provisions, ethical problems associated with it, how practitioners should address these conflicts.

The affordable care act

The Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare, is a health reform signed and implemented in March 2010 by Former president Barak Obama. The reform focuses on expanding Medicaid eligibility. With ACA, children remained covered by their parent’s insurance up to the age of 26. It also narrowed the chances of insurance companies denying insurance, making more people more insured. It aims at making healthcare more affordable and accessible. It also protected the consumer rights ensuring the patients received quality healthcare at an affordable cost. The act also modified the billing processes.

Firstly, it impacted the physician reimbursement.  Before the implementation of this act, medical practitioners usually worked under a fee-for-service system. Physicians would lender services and then bill the patients through the insurance company. Payment amounts relied on the Medicare physician fee schedule, which compensated the practitioners according to the expense required to offer patient services. However, under the ACA, this changes completely. The physicians are paid through a value-based payment modifier. This method requires the physician to indicate the patient outcomes to the center for Medicare services. It also vacates 575 billion dollars from Medicare payouts, causing the physicians to achieve lower payments. These cut-offs are reinvested to improve the quality and safety of medical services. This makes it possible for all patients to receive quality care. Even if the ACA is an added advantage to the patient, it affects the livelihood of the physicians.

Impacts of ACA on the physicians

ACA significantly reduces the physician’s earnings because they are paid according to the quality of services provided and not necessarily on the expenses of rendering the service. Moreover, there are fewer medicare payoffs since a percentage is directed to improving quality. Physicians also end up running losses due to quality issues. Even if the physician’s income reduces, this does not happen for the student loans and peer-head certifications, which need to be paid for. Physicians find themselves turning to other practices to improve their earnings. These practices are ethically questionable.

Ethical conflicts that arise due to ACA

As practitioners work their way around managing losses they incur, they tend to compromise the quality of care rendered to patients. This is because they focus on treating more patients to increase their reimbursements and will not entirely focus on providing quality care. This violates the ethical codes in the medical field, which exects all practitioners to solely focus on the provision of high quality services to attain the quality patient outcome. As the ACA demands that practitioners offered high quality services at a lower cost, thy increase their selectivity of patients in order to safeguard their payment rates. Initially, treating a high-risk patient was beneficial because they were compensated for the expense s of rendering the service. However, with ACA, it no longer becomes valuable to treat a high-risk patient. This is because the practitioner faces a risk of the increased cost of care due to the higher chances of complications and may result in poor patient outcomes, which will negatively affect their value-based payment modifier and hence lower payoffs. This reduces the chances of high-risk patients from attaining treatment. Practitioners find themselves opting to treat a patient with lower risks and have a chance to yield high quality patient outcomes. This has created an ethical dilemma because the burden of denying care is passed from insurers to physicians. Ethical codes expect physicians to tend to all patients equally. However, choosing a low-risk patient over a high-risk patient is actually discriminatory and unethical.

How nurses solve these ethical dilemmas

Nurses have continuously faced ethical dilemmas through history that related to justice, quality, and professionalism. The choice of pursuing nursing means that a person is ready to follow the ethical codes in the field. A nurse is obliged to help a person in need. Nurses are also expected to be nonjudgmental about their patients. They should, therefore, act in the best interest of the patients. A nurse is also expected to be caring and willing to accept responsibility. Throughout history, nurses have followed the nursing code of ethics and are expected to follow it to the letter. Nurses must always adhere to the principle of justice and fairness. Therefore, regardless of the patient is a high risk or low risk, they all require equal opportunities to attain medical care. Nurses should focus on maintaining the client’s interests as primary, which is to achieve quality care and achieve a quality outcome. Nurses should, therefore, ensure that the patient achieves a high quality medical services. The ACA pays out enough money to make sure that all services are upgraded up to quality.  Therefore, patients have the right to get quality services, and the nurses should make sure of it. Moreover, the ACA guarantees good pay for the high quality services. Therefore, regardless of the patient having high risks, it is the role of the practitioner, and the nurses to work together to ensure high quality services because it is a win for both the patient and the practitioners. Practitioners are mandated to consult with each other to solve a problem. By consulting with other practitioners, they can solve the problem instead of leaving the patient to suffer. Nurses should also focus on quality and not quantity, treating patients in better ways and not many patients.

The draft makes of the ACA clearly did not involve the practitioners and therefore fails to consider their needs, and this will create provisions that will district the ability to deliver care services to patients in the future. Nurses have a right to raise their grievances by addressing this issue to the labor unions.  This is to get the attention of the lawmakers who should pay close attention to the needs of the health practitioners and propose reforms that ensure high quality services but not at the expense of the practitioners.

What happens when patients to don have insurance?

The ACA only provides more affordable healthcare services to people with insurance. People who do not have insurance are actually penalized for discouraging people from staying without insurance. This fine is called shared responsibility payment. However, the fine has not been active since 2019. However, depending on the place on resides, they may be required to pay an extra fee while filing state taxes. One who is not able to pay for healthcare and haven’t taken an insurance cover faces the risk of having a large number of debts. Therefore, health insurance is considered a necessity instead of a luxury. However, if the person can afford the healthcare directly without the insurance, then they can pay directly through cash, unlike the insured people who pay through insurance companies.

Conclusion

The Affordable Care Act is one of the most important health reform done in history. It has helped many people who were not insured get insurance coverage. This has helped many people to access quality health care at a minimum cost. However, it has brought problems to practitioners since it has lowered their reimbursements. As the practitioners focus on protecting their reimbursements, they are focused on providing poor services, trying to increase the number of patients they attend to in a day. They also are inclined to opt for low risks patients and reject high-risk patients. This is highly unethical. Health practitioners ought to consider the patient’s health first as mandated by their professional ethics. Their goal is to provide quality healthcare to all patients, even if they are of high risk or low risks. The issue on the ACA provisions should be settled with the policymakers, where they should seek to strike a balance where high quality services can be provided at a low cost without compromising the earnings of the health practitioners.

References

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