Ethical Case Analysis from a Leadership Perspective
As premiums have gone up each year and health care costs have sky-rocketed, more and more costs have been shifted to consumers with deductibles and co-payments increasing and covered services decreasing. The Affordable Care Act will provide direct financial care and relief to millions of Americans insured and uninsured in North Carolina and help families that are struggling to pay health insurance premiums (Families USA, 2012). One of the primary reasons for passing the Affordable Care Act is to make health insurance more accessible and affordable. In North Carolina, approximately 1.7 million non-elderly people, which is approximately 20.4 percent of the non-elderly population, were uninsured in 2009 (Silberman, 2011).
Summary of the Case
The Affordable Care Act gives hardworking families in North Carolina the protection they deserve. The new healthcare law forces insurance companies to play by the rules, prohibiting them from dropping coverage on anyone that gets sick (Holmes, 2011). It prohibits the insurance companies from invoicing individuals if they become bankrupt due to an annual or lifetime limit. In the future, state law may prohibit discriminating against anyone with a pre-existing condition. Middle-class and low-income families need relief from rising healthcare costs. The Affordable Care Act, when fully implemented, will provide touchable and measurable relief to North Carolina families. Each individual will have the security of knowing they do not have to worry about losing coverage when changing jobs or being laid off. Insurance companies are required to cover preventive care, such as mammograms and other cancer screenings tests. The new laws make significant investments in state and community-based efforts that promote public health, prevent diseases and protect against public health emergencies (Fielding, 2012).
The newly opposed law gives families the option of shopping for insurance in other states. This would be an act of exchange to receive a discount on premiums through a refundable premium tax credit. The Affordable Care Act will also help people who have insurance by protecting them from high deductibles, high copayments and unexpected gaps in their insurance coverage. There are three different ways it will eliminate lifetime and annual limits on how much a health insurance company will pay to cover benefits so that their plan does not expire, it will place a cap on how much a person has to spend each year on deductibles and copayments for covered benefits, and it will provide additional help on out-of-pocket costs for lower-income families (Reinhardt, 2000).
Synthesis of the Case
Many of the uninsured people who gain insurance coverage by 2014 will obtain their coverage through the state’s Medicaid program. Beginning in 2014, the Affordable Care Act requires that states expand the Medicaid coverage for most uninsured adults with a modified adjusted gross income. In the future, major expansions to the North Carolina Medicaid program will create changes in requirements for being eligible, especially for low-income adults. To qualify, current persons must be a citizen or lawful permanent immigrant in the United States for at least five years and must meet certain classification, income and resource requirements. To put this into perspective, a person working at minimum wage ($7.25hr), 40 hours a week and 50 weeks per year would earn $14,500 a year. The incomes of these low wage workers are generally too high to qualify for Medicaid under North Carolina’s current Medicaid eligibility rules. A parent can possibly qualify, but it is highly unlikely. A parent in a family of four would only qualify in North Carolina if his or her income was less than $7,128 per year, equivalent to less than half of what a person earns on minimum wage. However, beginning January 1, 2014, these adults will be able to qualify regardless of whether he or she has children (Sommers, 2011). A single nonelderly adult who is not disabled cannot currently qualify for Medicaid in North Carolina regardless of income. This current law is not right and needs to be changed. A parent in a family of four would only qualify in North Carolina if he or she has children.
Summary of the Leadership Perspective
From a leadership perspective, it is important to continue to develop a healthcare plan for the poor, unemployed and homeless within our society and make it work. Therefore, it is important to identify that being a transformational leader will champion the effort. Transformational leadership starts with the development of a vision, a view of the future that will excite and change potential followers. An example would be to work at a state level to make health insurance affordable to everyone, whether they are rich or poor and whether they have a job or not. Transformational leaders must be respected within the state and in the rural communities in order to unite healthcare professionals, business, community leaders and other stakeholders needed for the success of the healthcare initiative (Trofino, 1995). The leader will serve as the public’s face on the health insurance initiative, requiring them to be well-spoken and well-educated on the objectives of the healthcare issues. The transformation leader’s goal is to have a clear understanding of the initiative, a thorough knowledge of their community and ideas on how to achieve those goals within the community. Leaders should be able to identify the individuals or organizations that need to be involved with the initiative. The leaders will need to create and nurture the enthusiasm and energy needed to sustain the effort over a period of time. Leaders often need strong interpersonal, motivational and organizational skills in order to facilitate the work of individuals and groups. They also need to be good problem solvers in order to identify strategies to overcome any barriers that may arise. While strong leadership is critical to the success of any healthcare initiative, successful community-based projects also involve the work of many other key individuals.
Synthesis of the Leadership Perspective
The implications of being in a leadership role in healthcare could help individuals in a time of need. Several of the ways we can help this situation become a reality is to improve access to services, improve the quality of care, increase cost efficiency, improve coordination among primary healthcare, improve accountability for Medicaid expenditures that results in the decrease of risk of cost overruns for the state budget and increase of savings that remain in the public system that can be reinvested into service delivery (Norton, 2012). All of these are wonderful ideas, but one has to have a leader to make this transaction happen. An explanation of this would be to improve the quality of care; however, from the leadership perspective one should strive to provide the best quality of care available. Treating someone the way you would want to be treated and showing kindness will go a long way when caring for patients. A patient will overlook a facility not having new technology as long as the patient senses they are being treated kindly and receiving the best quality of care. It is so important to make the patient feel wanted from the time they are admitted to the time they are discharged, whether they come into the facility for an emergency or as an elective stay. Quality is raising the bar for excellence in healthcare and increasing access to evidence-based services. The increased cost efficiency would be an easy topic to tackle; healthcare spending can definitely be more efficient. Purchasers can be offered a narrow network insurance plan that provides incentives for them to select doctors, hospitals and treatment options that rate higher on quality and cost-efficiency. Tiered network plans offer consumers lower co-pays for selecting higher-quality, cost-efficient providers within the plan’s provider network. Narrow network plans limit consumers to a smaller group of providers that offer higher quality and cost efficiency.
Economic Analysis
Health economics is concerned with the evaluation of the effectiveness of healthcare, particularly when examining the social opportunity costs of alternative forms of treatment. Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the function of healthcare systems, as well as health-affecting behaviors such as obesity. Economic Analysis in Healthcare provides a comprehensive coverage of both the economics of healthcare systems as well as the evaluation of healthcare.
Hospital cost shifting makes up a large and growing share of the healthcare premium dollar and is largely dependent upon the share of a hospital’s revenue structure that is Medicare. The cost shifting argument has some very problematic implications and little to no firsthand support. Hospitals and insurance companies both set prices to maximize profits, and hospitals charge private insurers the maximum amount possible, regardless of whether they receive payments from Medicare. Lower prices from one payment source may affect the hospital’s profit margin, but should not cause the hospital to increase the already profit maximizing price it charges private insurers. One exception to this would be if hospitals are operating near bankruptcy and are wanting to keep prices as low as possible, in which case a decrease in one customer’s payments would lead to an increase for another customer, because the hospital has not been charging the second customer a profit maximizing price in the first place. Whereas this is possible ideally, there has been no good observed work documented. The best research that one can see in the behavior of non-profit hospitals suggests that non-profits behave identically to profit hospitals (Reinhardt, 2000). The policy choices for the administration of the public option hinge on four decisions, each with potentially important cost implications. First, the public option could pay providers the Medicare rate or pay private market rates. Second, the public option could use the same administrative method as Medicare, or an entirely new method. Third, Medicare providers could be required to accept patients with the public option or not. Fourth, provider participation in the public option could be set up as an opt-out or as an opt-in. Each of these decision points will affect the magnitude of expected cost savings. The results within this article suggest that as market concentration increases, hospital cost shifting increases. However, the relationship is weak, especially when compared with the association between public payers and cost-shifting behavior (Norton, 2012).
Application to macro and micro systems
Microeconomics deals with economies on a small scale with a lot of math involved. Macroeconomics deals with economies in the big picture, globally. There are fewer math’s in macro, but it is still included. In general, micro analysis will be analyzing each individual part of a system. Macro analysis will be analyzing the system, or set of systems as a whole (Kosnik, 2003). The intuitive belief of various system levels, such as the microsystem and macrosystem,
has to do with the number and strength of interconnections between the fundamentals of systems. For example, one can use a doctor’s office or clinic in describing a microsystem. It is small and self-contained with relatively few interconnections. Patients, physicians, nurses and office staff interact to produce. In order to examine the macro environment and possible opportunities or threats the private healthcare sector in the United States has to face, one needs to know where to start with the application. It can be said that there is no real public insurance program that exists for the majority of people in the United States. The government only provides coverage for the elderly, needy or poor people in the insurance programs of Medicare and Medicaid (Fielding, 2012). The majority of private health insurance is due to the common policies of employer-based private insurance. However, the financing of the United States healthcare system is shared by the government and the private insurance companies, which can be referred to as the payers and the United States as a multi-payer system.
In Alabama, there are 573,000 people uninsured; this consists of about 14.9 percent of Alabamians. One article researched began examining state characteristics that are likely to be important in generating variations across states (Holahan, 2003). The state should perform an estimate of the effects in a set of evidenced-based standard strategies that have been evaluated in prior research, focusing on the diversity of their effects. The state calibrates the baseline findings so that the national effect of each strategy corresponds to those widely accepted. The state classifies categories according to how a policy affects that state’s uninsurance rate relative to the national average.
The argument as to whether the proper healthcare policy is state or federal often contrasts interstate variability generated by state experimentation with the uniformity of federal health policy. The argument has been made that the federal health policymaker cuts greater healthcare expertise, betters revenue collection abilities and the ability to avoid the race to the bottom inherent in intrastate competition. There has been an emphasis placed on state policymakers using their understanding of local conditions to craft policies that best reflect states’ values and priorities. Uniform federal income eligibility limits will leave more people uninsured in high-income states where the cost of living is high. Uniform expansions in eligibility will have less effect on uninsured people in states that generously support safety-net providers and have expanded public program eligibility (Holahan, 2003). Identical tax credits will provide fewer benefits to the people in states where the cost of medical care is higher. In each of these situations, layering uniformed national policies over the existing differences among states will not necessarily narrow these differences. Instead, a policy goal of interstate uniformity in outcomes may require interstate variability in policies.
Conclusions
After researching this ethical case, we are still in an ever-changing world, and we must recognize that changes are inevitable and these changes reshape the social, economic and cultural landscape of the society in which we live. In addition, these changes impact the lives of the patients we serve and the environment of extension programs. (Weil, 2009) makes reference to the six major governmental healthcare extension programs, which are Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), the Department of Defense TRICARE and TRICARE for Life programs (DOD TRICARE), the Veterans Health Administration (VHA) program and the Indian Health Service (IHS) program that provides healthcare services to about one-third of Americans. The federal government has a responsibility to ensure that the more than five hundred billion dollars invested annually in these programs is wisely used to reduce the burden of illness, injury, disabilities and to improve the health and functioning of the population (Woodrow, 1991). It is imperative that the federal government exercise strong leadership in addressing serious shortcomings in the safety and quality of healthcare in the United States. This being said, we all have a big responsibility at the state and federal level to make this happen.
As premiums have gone up each year and health care costs have sky-rocketed, more and more costs have been shifted to consumers with deductibles and co-payments increasing and covered services decreasing. The Affordable Care Act will provide direct financial care and relief to millions of Americans insured and uninsured in North Carolina and help families that are struggling to pay health insurance premiums (Families USA, 2012). One of the primary reasons for passing the Affordable Care Act is to make health insurance more accessible and affordable. In North Carolina, approximately 1.7 million non-elderly people, which is approximately 20.4 percent of the non-elderly population, were uninsured in 2009 (Silberman, 2011).
Summary of the Case
The Affordable Care Act gives hardworking families in North Carolina the protection they deserve. The new healthcare law forces insurance companies to play by the rules, prohibiting them from dropping coverage on anyone that gets sick (Holmes, 2011). It prohibits the insurance companies from invoicing individuals if they become bankrupt due to an annual or lifetime limit. In the future, state law may prohibit discriminating against anyone with a pre-existing condition. Middle-class and low-income families need relief from rising healthcare costs. The Affordable Care Act, when fully implemented, will provide touchable and measurable relief to North Carolina families. Each individual will have the security of knowing they do not have to worry about losing coverage when changing jobs or being laid off. Insurance companies are required to cover preventive care, such as mammograms and other cancer screenings tests. The new laws make significant investments in state and community-based efforts that promote public health, prevent diseases and protect against public health emergencies (Fielding, 2012).
The newly opposed law gives families the option of shopping for insurance in other states. This would be an act of exchange to receive a discount on premiums through a refundable premium tax credit. The Affordable Care Act will also help people who have insurance by protecting them from high deductibles, high copayments and unexpected gaps in their insurance coverage. There are three different ways it will eliminate lifetime and annual limits on how much a health insurance company will pay to cover benefits so that their plan does not expire, it will place a cap on how much a person has to spend each year on deductibles and copayments for covered benefits, and it will provide additional help on out-of-pocket costs for lower-income families (Reinhardt, 2000).
Synthesis of the Case
Many of the uninsured people who gain insurance coverage by 2014 will obtain their coverage through the state’s Medicaid program. Beginning in 2014, the Affordable Care Act requires that states expand the Medicaid coverage for most uninsured adults with a modified adjusted gross income. In the future, major expansions to the North Carolina Medicaid program will create changes in requirements for being eligible, especially for low-income adults. To qualify, current persons must be a citizen or lawful permanent immigrant in the United States for at least five years and must meet certain classification, income and resource requirements. To put this into perspective, a person working at minimum wage ($7.25hr), 40 hours a week and 50 weeks per year would earn $14,500 a year. The incomes of these low wage workers are generally too high to qualify for Medicaid under North Carolina’s current Medicaid eligibility rules. A parent can possibly qualify, but it is highly unlikely. A parent in a family of four would only qualify in North Carolina if his or her income was less than $7,128 per year, equivalent to less than half of what a person earns on minimum wage. However, beginning January 1, 2014, these adults will be able to qualify regardless of whether he or she has children (Sommers, 2011). A single nonelderly adult who is not disabled cannot currently qualify for Medicaid in North Carolina regardless of income. This current law is not right and needs to be changed. A parent in a family of four would only qualify in North Carolina if he or she has children.
Summary of the Leadership Perspective
From a leadership perspective, it is important to continue to develop a healthcare plan for the poor, unemployed and homeless within our society and make it work. Therefore, it is important to identify that being a transformational leader will champion the effort. Transformational leadership starts with the development of a vision, a view of the future that will excite and change potential followers. An example would be to work at a state level to make health insurance affordable to everyone, whether they are rich or poor and whether they have a job or not. Transformational leaders must be respected within the state and in the rural communities in order to unite healthcare professionals, business, community leaders and other stakeholders needed for the success of the healthcare initiative (Trofino, 1995). The leader will serve as the public’s face on the health insurance initiative, requiring them to be well-spoken and well-educated on the objectives of the healthcare issues. The transformation leader’s goal is to have a clear understanding of the initiative, a thorough knowledge of their community and ideas on how to achieve those goals within the community. Leaders should be able to identify the individuals or organizations that need to be involved with the initiative. The leaders will need to create and nurture the enthusiasm and energy needed to sustain the effort over a period of time. Leaders often need strong interpersonal, motivational and organizational skills in order to facilitate the work of individuals and groups. They also need to be good problem solvers in order to identify strategies to overcome any barriers that may arise. While strong leadership is critical to the success of any healthcare initiative, successful community-based projects also involve the work of many other key individuals.
Synthesis of the Leadership Perspective
The implications of being in a leadership role in healthcare could help individuals in a time of need. Several of the ways we can help this situation become a reality is to improve access to services, improve the quality of care, increase cost efficiency, improve coordination among primary healthcare, improve accountability for Medicaid expenditures that results in the decrease of risk of cost overruns for the state budget and increase of savings that remain in the public system that can be reinvested into service delivery (Norton, 2012). All of these are wonderful ideas, but one has to have a leader to make this transaction happen. An explanation of this would be to improve the quality of care; however, from the leadership perspective one should strive to provide the best quality of care available. Treating someone the way you would want to be treated and showing kindness will go a long way when caring for patients. A patient will overlook a facility not having new technology as long as the patient senses they are being treated kindly and receiving the best quality of care. It is so important to make the patient feel wanted from the time they are admitted to the time they are discharged, whether they come into the facility for an emergency or as an elective stay. Quality is raising the bar for excellence in healthcare and increasing access to evidence-based services. The increased cost efficiency would be an easy topic to tackle; healthcare spending can definitely be more efficient. Purchasers can be offered a narrow network insurance plan that provides incentives for them to select doctors, hospitals and treatment options that rate higher on quality and cost-efficiency. Tiered network plans offer consumers lower co-pays for selecting higher-quality, cost-efficient providers within the plan’s provider network. Narrow network plans limit consumers to a smaller group of providers that offer higher quality and cost efficiency.
Economic Analysis
Health economics is concerned with the evaluation of the effectiveness of healthcare, particularly when examining the social opportunity costs of alternative forms of treatment. Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the function of healthcare systems, as well as health-affecting behaviors such as obesity. Economic Analysis in Healthcare provides a comprehensive coverage of both the economics of healthcare systems as well as the evaluation of healthcare.
Hospital cost shifting makes up a large and growing share of the healthcare premium dollar and is largely dependent upon the share of a hospital’s revenue structure that is Medicare. The cost shifting argument has some very problematic implications and little to no firsthand support. Hospitals and insurance companies both set prices to maximize profits, and hospitals charge private insurers the maximum amount possible, regardless of whether they receive payments from Medicare. Lower prices from one payment source may affect the hospital’s profit margin, but should not cause the hospital to increase the already profit maximizing price it charges private insurers. One exception to this would be if hospitals are operating near bankruptcy and are wanting to keep prices as low as possible, in which case a decrease in one customer’s payments would lead to an increase for another customer, because the hospital has not been charging the second customer a profit maximizing price in the first place. Whereas this is possible ideally, there has been no good observed work documented. The best research that one can see in the behavior of non-profit hospitals suggests that non-profits behave identically to profit hospitals (Reinhardt, 2000). The policy choices for the administration of the public option hinge on four decisions, each with potentially important cost implications. First, the public option could pay providers the Medicare rate or pay private market rates. Second, the public option could use the same administrative method as Medicare, or an entirely new method. Third, Medicare providers could be required to accept patients with the public option or not. Fourth, provider participation in the public option could be set up as an opt-out or as an opt-in. Each of these decision points will affect the magnitude of expected cost savings. The results within this article suggest that as market concentration increases, hospital cost shifting increases. However, the relationship is weak, especially when compared with the association between public payers and cost-shifting behavior (Norton, 2012).
Application to macro and micro systems
Microeconomics deals with economies on a small scale with a lot of math involved. Macroeconomics deals with economies in the big picture, globally. There are fewer math’s in macro, but it is still included. In general, micro analysis will be analyzing each individual part of a system. Macro analysis will be analyzing the system, or set of systems as a whole (Kosnik, 2003). The intuitive belief of various system levels, such as the microsystem and macrosystem,
has to do with the number and strength of interconnections between the fundamentals of systems. For example, one can use a doctor’s office or clinic in describing a microsystem. It is small and self-contained with relatively few interconnections. Patients, physicians, nurses and office staff interact to produce. In order to examine the macro environment and possible opportunities or threats the private healthcare sector in the United States has to face, one needs to know where to start with the application. It can be said that there is no real public insurance program that exists for the majority of people in the United States. The government only provides coverage for the elderly, needy or poor people in the insurance programs of Medicare and Medicaid (Fielding, 2012). The majority of private health insurance is due to the common policies of employer-based private insurance. However, the financing of the United States healthcare system is shared by the government and the private insurance companies, which can be referred to as the payers and the United States as a multi-payer system.
In Alabama, there are 573,000 people uninsured; this consists of about 14.9 percent of Alabamians. One article researched began examining state characteristics that are likely to be important in generating variations across states (Holahan, 2003). The state should perform an estimate of the effects in a set of evidenced-based standard strategies that have been evaluated in prior research, focusing on the diversity of their effects. The state calibrates the baseline findings so that the national effect of each strategy corresponds to those widely accepted. The state classifies categories according to how a policy affects that state’s uninsurance rate relative to the national average.
The argument as to whether the proper healthcare policy is state or federal often contrasts interstate variability generated by state experimentation with the uniformity of federal health policy. The argument has been made that the federal health policymaker cuts greater healthcare expertise, betters revenue collection abilities and the ability to avoid the race to the bottom inherent in intrastate competition. There has been an emphasis placed on state policymakers using their understanding of local conditions to craft policies that best reflect states’ values and priorities. Uniform federal income eligibility limits will leave more people uninsured in high-income states where the cost of living is high. Uniform expansions in eligibility will have less effect on uninsured people in states that generously support safety-net providers and have expanded public program eligibility (Holahan, 2003). Identical tax credits will provide fewer benefits to the people in states where the cost of medical care is higher. In each of these situations, layering uniformed national policies over the existing differences among states will not necessarily narrow these differences. Instead, a policy goal of interstate uniformity in outcomes may require interstate variability in policies.
Conclusions
After researching this ethical case, we are still in an ever-changing world, and we must recognize that changes are inevitable and these changes reshape the social, economic and cultural landscape of the society in which we live. In addition, these changes impact the lives of the patients we serve and the environment of extension programs. (Weil, 2009) makes reference to the six major governmental healthcare extension programs, which are Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), the Department of Defense TRICARE and TRICARE for Life programs (DOD TRICARE), the Veterans Health Administration (VHA) program and the Indian Health Service (IHS) program that provides healthcare services to about one-third of Americans. The federal government has a responsibility to ensure that the more than five hundred billion dollars invested annually in these programs is wisely used to reduce the burden of illness, injury, disabilities and to improve the health and functioning of the population (Woodrow, 1991). It is imperative that the federal government exercise strong leadership in addressing serious shortcomings in the safety and quality of healthcare in the United States. This being said, we all have a big responsibility at the state and federal level to make this happen.