Health Care Law and Ethics

The Nature of Medical Practice Is the delivery and purchase of health care like other products? Consider the 7 misconceptions relating to health care highlighted on page 9 Consider the following possible parallels. Whats wrong with them? Broken cars=sick bodies Diagnosis and repair=diagnosis and treatment Customer satisfaction-informed consent

The Nature of Medical Practice What prompts patients to seek treatment? What do patients expect from their health care professional?

Expectations of Patients and Doctors Patients expect their doctor to be: Trustworthy Loyal Helpful Friendly Courteous Kind Doctors expect their patients to be: Obedient Cheerful Thrifty Brave Clean Reverent

The Nature of Medical Practice Are these expectations realistic? Should patients be warned at the outset about the limits of medical treatment? What social significance attaches to a medical diagnosis? To what extent is there variability in medical decision making, and what are the implications of this?

Health Care Financing and Delivery Who are the principal players in the US Healthcare delivery system? Patient Physician Hospitals and other health care institutions (increasingly nursing homes) Employer Insurer and other payors (HMOs) Federal and state governments

Health Care Expenditures in Dollars (Billions)

Health Care Expenditures in % of GDP

Health Care Expenditures in $ Per Capita

Health Care Financing and Delivery Physicians Highly respected profession Highly compensated profession Highly specialized profession Traditionally a highly autonomous profession

Health Care Financing and Delivery Hospitals Originally for the sick-poor Often formed by religious organizations Historically, non-profits dominated Rise of the for profit hospital Relationship to physicians Employees (typically residents, pathologists, radiologists, emergency room physicians) The Medical Staff

Health Care Financing and Delivery Employers Pay premiums (subsidize premiums) to indemnity insurers Self-insured Erisa

Health Care Financing and Delivery Private insurers Blues Community rating Commercial insurers Experience rating Public payors Medicare Medicaid

Health Care Financing and Delivery Fee for service Reimbursement for whatever is ordered Managed Care (HMO, PPO, HPO) Capitation or other financial incentives Gate keeping Prospective utilization review

Health Care Financing and Delivery Medicare >65 <>65 Kidney Dialysis/Transplant Medicaid Federal/State Program ADC Other needing (elderly) Broader plan design Pharmacy Nursing Home Care

Moral, Economic and Political Themes Should health care be a universal right in the United States? Should health care be rationed? Is it currently rationed? How should we decide who gets the rationed health care?

Moral, Economic and Political Themes Should the health care delivery system be largely run by The government The medical professions The insurance industry Employers Would a health-care systems design differ depending upon who ran it?