Should patients have choice - Essay Example

Should Patients Have choice Consumers are becoming more involved in their care. Over the past 30 years, sources of medical information have proliferated, and the population in the countries like United States and United Kingdom has become increasingly better educated about their health care options. Medical suppliers, like pharmaceutical companies, are advertising directly to consumers, rather than to health professionals, since consumers are making more choices regarding their care and exerting greater influence on payers. The consumer movement in health care is still in its infancy, but the power that it will bring to bear on the system will be profound. It is an accepted fact that, there are three central ideas that permeate most applications of economic theory to the health care field. The first is to focus on the individual. Although economic theory does recognize the concept of 'social welfare,' it is generally conceived to be based solely on some aggregation of individual utilities. The second key focus of economic theory is the emphasis of efficiency over equity. Although individual economists are often concerned about equity, the traditional economic model does not examine how people come into possession of their wealth so much as how they allocate resources over which they have already been assigned property rights. The third over reaching theme of economic theory is the superiority of relying on consumer choice for the allocation of goods and services. The best way of providing a choice to the consumer or rather a patient is by listening to them and by offering them a choice to take their own decisions. This is possible only when an open communication is established. For instance, it is being noted in several cases, patients are no usually supported by physicians when they report their use of complementary medicine, and this makes patients reluctant to talk about their choices with physicians. Openness to patients choices can foster good communication between patients and their physicians enhancing trust. With open lines of communication, physicians also have the opportunity to provide warnings when they deem appropriate. The conversation should include the pragmatics of symptom relief, patients effort to research various therapies, patients feelings about therapies they are using or considering, patients decision making processes, and any possible interactions or harms. Opening communication on complementary medicine between physician and patients is important, but the findings have wider implication for communication between patients and physicians (and other heath care providers). Advocates of patient-centered communication between physicians and patients argue that physicians may pay attention to the "voice of the life world," not just the "voice of medicine". A value-centered approach to improving communication is in keeping with patient-centered approaches; patients values become central to negotiating a successful partnership. Many studies have demonstrated that communication between patients and physicians is often unsatisfactory to both. Patients and physicians values often do not match, making communication and the accomplishment of treatment goals difficult. In value-centered communication, patients and physicians would focus on building communication practices on a foundation of recognized, discuss, and, ideally, shared values. It is to be noted that any communication is good communication where the both the parties involve actively participate. It is not only the duty of the physician to enhance the relationship with the patient by educating and making them aware but also it lies with the patient to take ownership of their health, get empowered and take charge of their health care. Empowerment Empowerment involves a willingness to take risks, to move beyond that which is known and perhaps comfortable, to the unknown. It often requires a change in self-perception, developing a different vision of who we are. This can stimulate anxiety and fear. Physicians and other professional providers need to recognize such barriers and appreciate that not everyone wants to take the risks and assume the responsibility that empowerment demands. Paternalistic attitudes within the health care system have fostered reliance on health care providers to determine what patients need for health. Other barriers include patient lack of knowledge of resources or strategies that promote empowerment, dependency, apathy, mistrust, and being labeled by staff. Social, cultural, economic or political factors can present barriers such as limitation of resources, control of knowledge about options, locking people into traditional roles and expectations, social labeling that stereotypes and devalues certain people or behaviors and restriction of access to resources. Lack of empowerment of professionals and their inability to relinquish power to patients affect patient empowerment as well. Honoring patient decisions may be very threatening to physicians who do not appreciate that patients know what they need. We can facilitate empowerment in others by being role models of self-empowerment. As noted previously, belief that patients have the right and ability to make choices regarding their health, and other areas of their lives, is basic to empowerment. Patients need to be given opportunities for choice regarding small as well as major decisions. This means that there needs to be participatory decision making, involving collaboration and negotiation, in all areas of health care. For example, involving patients in making decisions about when they will bathe what foods to include in their diet, or when to take their medications is as important to empowerment as their participation in decision making regarding life support measures. Because of social, environmental, and other factors, some people have had limited opportunities for making choices and may need education, practice, and nurture in this area. Offering options and developing strategies to enhance the patient's ability to set and reach goals are important parts of the nursing role. Giving patients more choice Patients should have more choice of their treatment, who delivers it and when: This is possible only by: Enhancing the rights of patients by strengthening the patients charter and including rights to treatment within a specified time, a choice of GP, information about the options for treatment, guaranteed access to heath records and better redress. Ensuring that action is taken to improve poor quality services. Consumer Driven health care plans Even before the patients' rights debates heated up, concerns with high cost, restricted care and the poor experiences of patients with health plans and the health care system gave rise to another stream of reform proposals centered on consumer choice. Over the past decade, advocates of so-called consumer driven health care have raised the important issue of the need for consumer choice and information. The consumer driven approach renames patients as "consumers" and stresses that consumers are capable of making their own medical decisions. Harking back to the era when patients actually paid for health care directly, the consumer-driven health care movement also stresses that greater responsibility for consumers will reintroduce price sensitivity. The introduction of health savings accounts and other mechanisms that give consumers a stake in paying for their own care are prominent features of the consumer-driven health care movement. Many observers equate consumer-driven health care with the introduction of the market into the health care system. Consumers alone cannot realistically drive a transformation of the system, though they can play a supporting role in it. A transformation in competition will be needed, along with shifting roles, incentives, and time horizons for each of the major actors in the system. Indeed, introducing value-based competition among providers and health plans will revolutionize the value delivered to patients even if consumer behavior is slow to shift. Changes in competition at the provider and health plan levels will do more to shift patient choices than increasing consumers' payment responsibilities in the system. Consumer choice proposals have focused primarily on the choice of health plans as the locus of change, rather than the far more critical choices of providers and treatments. The role of the consumer is taken too far, as if consumers can replace doctors and make medical decisions entirely on their own. Consumer choice proposals highlight the role of employers in enabling information and choice for employees, but again through the mechanism of health plans. Without confronting the structural problems of closed networks that prevent meaningful choice of providers, however, consumer choice will not affect the decisions that most influence health care value. Consumerism in health care is driven by several factors: - The overall growth of consumerism in society. - Employers, who demand greater value from payers while forcing employees to become more involved on financial and intellectual bases. - Government purchasers, who view consumerism as a rationale for addressing the public's concerns about managed care in addition to problems with health care coverage and costs in the United States. - Private accreditation and advocacy groups, which include the NCQA - Media, which influences public perception by publicizing negative stories about MCOs - An increase in information technology, which offers increased access to health care information. - Societal trends such as the spread of anti-institutional sentiment, which leads consumers to question authority, and value places on self-reliance, which means that patients expect to take responsibility for their own health and health care. Overall, today's health care consumers are more educated, demanding, informed, time-constrained, choice hungry, responsive, and clear about their demands. The convergence of several technological, financial, and administrative and provider trends have led to the growth of a few frontiers in health care management: consumer driven health care (CDH) plans. Born from consumers' ready access to Internet based health information, employers' need to reign in steadily increasing health care costs, the cold reception to medical savings accounts and warm reception to health reimbursement arrangements, and restrictive plan language, consumer-driven health care plans are giving individuals greater choice, responsibility, control, and difficult decisions to make. These and other self directed plans fall under the defined care or defined contribution health care model. In ordinary health care circumstances, in all western countries, the adult individual, who is capable of making an autonomous choice, is granted an absolute veto against treatment; he or she is allowed an absolute right to reject whatever kind of treatment he or she need. A grown up patient, for example, who has a vital interesting having a blood transfusion is allowed to abstain from the transfusion for whatever reasons he or she may have. The doctor may consider the reasons very poor. Yet, for all that, the doctor has to accept the decision made by the patient. The patient has a right to die from his or her illness. In the US there is even a federal law to this effect. On 1 December 1991 The Patient Self Determination Act - a federal law known as the PSDA - went into effect in the United States. It was the first federal legislation regarding life sustaining treatments. The situation is different in Japan, of course. Not only do physicians have great authority with respect to the patient, but the autonomy of the patient is restricted also by considerations regarding his or her family. Of course, in all countries, a patient who is unconscious when admitted to an intensive care unit will be treated without having previously given consent. If necessary, the patient will be operated on or given blood transfusions and so on, if this is considered to be in their best interests. In the circumstances, it is simply taken for granted that this is what the patients want. This is taken care of in Article 8 of the Convention: When because of emergency situation the appropriate consent cannot be obtained, any medically necessary intervention may be carried out immediately for the benefit of the health of the individual concerned. However, if the patient wakes up from the coma and states that he or she does not want any continued treatment, or not continued treatment of a certain kind(such as blood transfusions), and if he or she is capable of reaching a decision(he or she is not confused because of the illness), and he or she is informed as to consequences of refusal, his or her 'no' will be taken for an answer, even if it means that the patient, who could have been cured, will die. If the patient has not reached an autonomous decision because he or she is not capable of doing so, then physician may exercise his or her right on his or her behalf, treating the patient as we see fit, in his or her own best interest. When doing so we act on the presumption that this is what the patient would have decided, had she or he been capable of reaching an autonomous decision. However if the reason That the patient did not reach an autonomous decision was that he or she did not bother to try to do so, or did not want to do so, then we should not coerce the patient. In some situations it is possible to tell whether the patient's refusal to take an autonomous decision is due to lack of a capacity or a will to do so. Then it is appropriate to coerce the patient, in hope and I the expectation that the decision reached on his or her behalf will come eventually to be endorsed also by the patent. Conclusion: Although the consumer choice market is growing at an alarming rate, yet, the efficiency and the benefits involved in considering the consumers decision is causing problems in the health care market. This area of study in the heath care is a difficult subject to research, and few methodologically sound studies investigating the effects of patient participation have been published. Retrospective studies face the problem that patients perception of involvement in decision making may have been influenced by the outcome of the treatment. For instance, there are fears that encouraging patients to choose between competing treatment options places an additional burden on people who are feeling unwell and could cause anxiety and distress. Prospective studies involving independent assessment of the extent of participation would be required to overcome this problem. Shared decision making should involve sharing information about the limitations and risks of treatment. Patients with serious disease may prefer an optimistic rather than a realistic account of their chances of recovery. Attempts to introduce a more evidence-based approach to treatment decision making may serve to invalidate patients values and beliefs and inadvertently undermine their coping strategies. Involving patients in treatment choices has the potential for harm, therefore, but it could lead to beneficial outcomes. If decision making is to be shared, the information to inform decisions must also be shared. Patients must be given help to obtain the information they need. Thus, giving patient a choice is a good activity but even before providing them with a choice it is general awareness and required knowledge that needs to be imparted to them. References: Baum, Neil & Zablocki, Elaine (1996) : Take Charge of Your Medical Practice - Before Someone Else Does it for You . Jones and Bartlett Publishers. Kongstvedt Reid, Peter (2003) : Essentials of Managed Health Care. Jones and Bartlett Publishers. Rich, Robert (2005) : Consumer Choice: Social Welfare & Health Policy. Transaction Publishers. Sheaff, Rod (1996) : Need For Health Care. Routledge Publishers. Zhou, Huizhong (2001) : The Political Economy of Health Care Reforms. W.E Upjohn Institute Publishers. Read More