Evaluate economic, legal and ethical impacts on the quality of healthcare provided to patients - Research Paper Example

? Evaluation of Economic, Legal and Ethical Impacts on the Quality of Healthcare Provided To Patients Table of Contents Executive Summary 2. Define the Problem or Issue in a Single Statement 3. Literature Review 4. Problem Analysis 5. Possible Solutions 6. Solution and its Implementation plan 7. Justification 1. Executive Summary This assessment seeks to evaluate the effects of ethical, economic and legal factors affecting the quality of medical services delivered to patients in health institutions. It begins by the definition and description of quality health services and then proceeds to study the contemporary environments in the health service institutions. The scope of this study is not limited to any particular health institution. However, from time to time, it will make reference to sample scenarios in various health institutions. The assessment will proceed to identify the benefits that patients receive from typical health centers and possible areas of improvement. It will also identify practical problems that patients face typical health centers and the relevant solutions that can be applied to mitigate the problematic situations. The study is based on various worldwide outcries about breaches of legal and ethical terms of services, including forceful application of euthanasia on inpatients. The study also investigates the existing claims of violations of the rights to confidentiality and unprofessional harassments on patients in reputable institutions. Ethical issues will include dishonesty and elements of corruption in certain health service centers. The claims prompt the assessment to stretch to the investigation of physical assaults, verbal insults and planned murders of patients undergoing treatments in hospitals. On the economic grounds, the study will investigate the claims on denial of treatment to certain classes of patients based on their inability to pay the medical costs. The ultimate aim of the study is to address the ethical, economic and legal issues affecting healthcare service quality and to improve the conditions under which patients receive treatments. 2. Define the Problem or Issue in a Single Statement The definition of quality health services is based on the satisfaction that the patients receive from the health units and whether they recover from their conditions or not. It also depends on the level of literacy of the patients that determines their knowledge of their fundamental legal rights. Quality service can be defined as the health service that provides favourable treatments to patients and enables them to recover from their poor health challenges. In essence, the aim of patients who approach medical centers for treatment is to recover from ill health conditions and to receive mature treatment full of respect. This assessment is investigating a major hypothesis and claim by patients from various health centers that: The mistreatments and the violation of the fundamental freedoms of patients to access medical services is influenced by the prevailing Economic, ethical and legal factors. Medical services as the patients claim expose them to mistreatments and violation of their freedom of access to treatments. Whether the problem statement is true or false will be determined by the critical analysis of case scenarios in practical environments. 3. Literature Review Economic factors In the United States of America, health care is almost exclusively restricted to the working class. This is because majority of the health care system and centers charge high fees and implement their services through medical insurance policies. The low level economy class definitely can not afford to access medical insurance. The indicator to the massive exorbitant medical costs reflects in the contribution of the medical sector to the GDP of the U.S. economy. Practically, the medical sector contributes 18 percent of the US GDP; approximately $2.5 trillion annually. This is obviously higher that the contribution of other sectors to the economy. Even though the quality of health services is perfect, many people can not afford it. The recent medical reforms introduced by President Obama, branded Obama healthcare has provided a certain amount of change in the quality of services ant treatment of various social and economic classes. It provides special attention to children and the old people in the society, the stages of life that demand a lot of medical care. By subsidizing the most vital health services such as maternity, the number of child mortality cases has thus gone down by large margins following the reforms. In the third world countries, the situation is worse, considering the large number of patients who seek medical attention and the impact of poverty. In Africa, the analysts have found out that about 30 percent of mothers undergo home delivery because they cannot afford the expenses of hospital maternity. Those who approach hospitals end up being detained in hospitals for as long as the medical bills are pending. At the same time, due to the poverty level, they cannot access the right nutrition, leading to health risks for both the mothers and their children. On the other hand, the middle class and the rich families are able to access specialized treatment in high standard hospitals. Humanitarian organizations have intervened in very serious conditions during disease outbreaks such as cholera and Ebola, which incidentally have only been dominant in the developing countries. The high rates of global economic inflation have exposed the poor families to situations where the qualities of medical services they can acquire are limited to external intervention from humanitarian organization or well-wishers including private investors and the vast business communities. As a result of poverty, transportation is a major challenge to the poor families, hence patients travel long distances to access medical facilities. As the World Health Organization documents, the level of inflation continuously locks out the poor families from quality health services, especially in the marginalized regions of the developing world. Considering the exorbitant costs of health care, many people both in the developed countries and the developing world opt to have insurance policies to enable them pay for procedures that are reliable enough to save lives. To that effect, many discussion forums concerning health care and the necessary reforms usually revolve around the use of health care insurance and how to avail them to those who cannot easily access them for quality services. The fact that Insurance companies operate based on the monthly premium contribution, Medical institutions usually need the assurance that the insurer will pay the expenses in case of any disease outbreak. In the United States of America, the insurance companies that finance health services receive more money in form of monthly premium that enables them to pay out the medical claims and still maintain profitability in the market. About 65 percent of the American population depends on the group health insurance that receives premium contribution from their employer. The federal government offers medical subsidies by waiving the taxes on the premium contribution; hence many employers are able to offer health insurance, being one of the non-taxable benefits. Somehow, the Federal taxation policies offer sufficient subsidies that in large scale, offers flexibility for the employers to make collective premium contributions. The unemployed and the self-employed who do not have access to such form of premium in the United States of America must buy medical insurance covers at various rates, which is still exorbitant for them. This still locks out a section of the vast population of the USA citizens and similar social classes in the rest of the continents. Obviously, lock the compulsory use of medical services mean that the patients with already identified disease conditions could still out of the medical covers and subsequent improved health services. One of the alternative sources of health services that majority can afford in the USA and the global domain include groups like AARP and COSTCO. They do not experience an influx of payment claims from Hospitals because their clients receive high quality health care hence they eradicate frequent cases of diseases. The Federal government of the United States of America also provides subsidies for health care for the elderly population of above 65 years of age. Legal factors The legal and justice system in the United States American responds to legal issues concerning medical mishaps and unprofessional behaviors among the medical experts as well as the accidental incidents that. Cases have been reported in the hospitals in the United States of America of doctors delaying in their services such as surgical operations that have caused patients to die in the process. Other legal cases have involved patients engaging doctors in their decisions to have voluntary euthanasia, and the doctor quickly takes the task without the patients signing their consents forms. These have left a number of Doctors in legal issues. Certain Hospitals in the third world have employed unqualified professionals in their institutions, who have ended up prescribing wrong medication for patients, which have complicated the already deteriorated health conditions of the patients. Other legal suits in the developed countries involve doctors who have prescribed wrong doses of medicines. This exposes the patients to risks of contamination of their blood hence causing more complication. Unprofessional medical centers have left sensitive treatment procedures to interns from various medical training institutes to the detriment of the patients’ lives and safety. Indeed, cases have been reported of interns who mishandle the procedures and ended up either killing the patients or causing more complications. Medical practitioners have interfered with the quality of health services by violating the fundamental rights to confidentiality of the patients. There have been cases where doctors have revealed the health conditions of the patients to third parties other that the next of kin. This is a direct source of legal instability. The processes of handling the delivery patients have identified that some male gynecologists take advantage of the mothers and molest them sexually. This has scared a section of the expectant mothers added to the fact that even female midwives apply inhuman harassments on them during child delivery. Of course this in the developing world where majority of the mothers do not know their legal rights to receive healthcare services, these cases go unreported. Patients undergoing treatments of chronic terminal diseases also reportedly receive unlawful treatments as some of the medical experts consider them as “Death row” patients to whom treatment is a waste of time and necessary resources. They reportedly receive mistreatment instead of the much needed tender care. These cases of neglect have seen some patients or their custodians file legal suits against the medical experts. For example, HIV patients have in the past persevered under brutal treatment before the introduction of voluntary testing and counseling programs. The brutal stigma without proper counseling, discouraged patients from being open with their HIV conditions, and ended up suffering even more. The climax of the mistreatment that in the past has attracted legal challenges is in the secret application of the HIV conditions in the employment policies. Companies dismissed the patients from their employment against legal and procedural terms, due to their HIV positive conditions. Medical Insurance companies also place conditions that exclude people with terminal diseases, considering them as high risk clients, whose probability of claiming medical payments is almost certain. This conservative behavior of medical companies has been a legal issue for many decades. This has been a familiar complaint. Medical experts, lawyers, and even their political contact points have been in disagreement over preventable medical results and the massive costs of legal procedures for about three decades. In the 1970s, there was a crisis with insurances when various countries made attempts to change the reform process and impose charges for damages and rectifying the contemporary and the existing frameworks (Emanuel, 1996). The reforms enabled the insurance companies to regain stability in the market and experience a reduction in the liability costs. Even so, the insurance industry failed to offer long term solutions to fix the prevalent health care problems with the legal experts. They did not realize then that the direct expenses of the liability system were not vital sections of the entire healthcare expenses. The socio-economic, ethical and medical challenges in the United States of America liability regulations and principles are different from the issues of legal caps and also are much deeper than the legal issue. The reforms in the application of legal factors in the health care services caused certain fundamental changes that directly influenced the quality of services that patients receive in the health centers. These reforms include: Application of restoration of the patients’ respect and professional treatment. The patient and his or her family members have to be restored as a way to apologize for violation of their legal rights. The restoration may include payment of monetary value for the economic losses and the related unprofessional actions. The reforms demand that the restoration has to be efficient and effective in articulating the needs of the patients and their close relatives. In cases where the medical experts and service provider violate the patient’s fundamental rights, there should be accountability and there should not be any attempt to hide evidence. Of course in many cases, the evidences attract disciplinary actions. Concealing evidences worsen the situation even more. In some cases, there is an application of flexible and lenient remedial actions including verbal caution and reprimands. In extreme cases, the evidence may call for the termination of the medical experts from service, based on the evaluation of the terms of service. The reforms consider errors as opportunity for learning and development in the career lines. This according to the reform agenda is to improve the future quality of healthcare services and safety by learning from the present mistakes. The legal procedures of the healthcare environment don’t have to mean harm to the medical experts and the patients, but actions of effective partner in the medical field to improve the performance of the medical service quality. Ethical Factors Ethical factors have proved to be influential on the quality of healthcare services that patients receive from health centers both to the positive and negative ends. The negative effects of the ethical factors are in corruption, dishonesty, poor attitude and emotions, harassment, unprofessionalism, discrimination and conflict of interest. In the positive, patients have been able to receive hospitable treatments and personal support services (Koschnitzke et al., 1992). Corruption comes out in the medical centers in various forms as it has been noticed by previous scholars. Simple forms of corruption occurs where some patients avoid queuing as required by the normal procedure and skip the queue due to their affiliation to certain hospital staff members. This happens in the open and at the expense of other patients, some of whom require emergency attention. Other grand forms occur in the misuse of the health facilities and resources to the detriment of the patients. After the government declares the national budget and resource allocation in various countries, government officials realize the opportunities to steal and personalize certain resources including funds at the expense of the main beneficiaries. In the case of medical budget, the main beneficiaries are patients undergoing treatments, and who are the tax payers to the economy. When members of USA Congress failed to agree with the president in the recent meetings that would address certain deficiencies in the budget and the progress of the medical health care services, many workers in the medical sector were worried about what would become of the subsequent national budget allocation for medical services. They thus expressed their worry over the resulting budget reduction that would affect the research projects in the USA, as well as other vital aspects of healthcare services. Some of them raised questions about the transparency and the ethics of such actions since it had the potential to devastate the sector of healthcare both at present and in the coming years (Kofke & Rie, 2003). In many parts of the world, honesty is usually lacking since many medical practitioners like to conceal their weaknesses to avoid appearing unprofessional. Cases have been cited where medical practitioners deliberately recommend wrong tests for where diseases are almost obviously predictable. They do that as they take advantage over the patient’s ignorance, to maximize on the earnings from the services, especially where medical insurance covers are concerned. Where hospitals employ fewer workers than necessary, the medical experts tend to work extra hours, which essentially lowers their productivity and destroys their attitude towards their works. This is unethical and of course a factor that works against the quality of health services, as the hospitals attempt to reduce costs of operation. Ethical issues in the healthcare sector are also evident in the unwillingness of the staff members to serve patients. Perhaps the major cause of this is the low scales of compensation, leading to dissatisfaction of the staff members and possibly industrial unrests. Almost all decisions that the hospital administration makes has an ethical impact on the patients, the hospital staff and the external service providers. Poor attitude and failure to control emotions is prevalent among the medical staff members and cases them to take official issues to personal levels, which is unethical and unprofessional. There are of course issues that affect workers at work place and cause a lot of stress, and impact poorly on the hospital administrators as well as the clinical workers. Hospitals have to prepare programs for discussion such issues and offer trainings, one of which is in the area of stress management and professional customer service delivery. Harassment is common among clinical nurses and the support staff in many hospitals. This manifests in the ways in which they issue commands and how they respond to questions and problems. Harassment indicate that the medical experts are not patient with their patients and do not care about them as a matter of priority (Bottrell, 2002). Conflict of interest occurs in the offices where medical officers concentrate on other personal activities other than the core business of the hospitals. When they spend working hours on personal activities, the service delivery quality dwindles. This endangers the health and safety of the patients, and leads to possible losses of lives. This has been experienced in many parts all over the globe, where laxity of medical officers or personnel in attending to the patients has caused serious health issues. When personal things or issues are mixed with professional work, definitely the quality of the services offered is going to go down because there will be a conflict of interest between the personal issues and the professional work. Therefore, to avoid deterioration of quality, it’s always important to ensure that medical officers concentrate on their work while at their work places (Peraino, 2002). Unprofessionalism manifests in medical healthcare centers when the medical experts begin to engage in activities that go against the policies of the medical centers and which violate other people’s rights (Freedman et al., 1992). Cases have been reported of medical experts who develop love affairs with their patients, thus degrading the image of the hospital. In other cases, medical experts have been engaged in business dealings with their patients which go against the code of conduct and ethics. Of course all these dealings and relationships discourage other staff members from upholding the moral standards. Conflict of interest consumes the energy from the medical experts such that they cannot devote themselves fully to their occupations. They work with divided attention and can end up causing unnecessary harm to the patients. Finally about ethics is the issue of discrimination, either in form of gender, tribal, racial or religious discrimination. This manifests in favorable treatments that the medical experts offer to some patients in preference to others, which denies them the right to access equal service quality. 4. Problem Analysis Having considered the examples of the problems that face the healthcare sector, we now take a critical and detailed analysis of the causes of the problems with an aim of formulating structured framework for solutions. The first point is on the causes of legal factors that affect the medical services delivery. What appears to cause or propel the occurrence of these activities is not deliberate. Some of them are tempting situations against which the medical officers cannot stand. Some of them are a show of ignorance of legal procedures and the implication of the medical works (Davidoff & Batalden, 2005). A medical expert for example performing surgical operation before allowing the next of kin of the patient to sign for consent is an indicator of ignorance about the implications of the absence of binding legal agreements and the power of consent (Nerenz et al., 2003). Other cases which are rare according to the studies are the employment of unlicensed doctors. This endangers the lives of the patients and the doctor risks legal fights with the medical laws. Other causes can be braches of simple common laws such as the disclosure of patients’ information to the third parties. This, like in any other field is a criminal offense. Deliberate compromise of rules and regulation is very dangerous. Causes of ethical issues arise from compromise of standards and morals for the sake of temporary gains. For example, corruption is merely an avoidable temptation. However, Acts of corruption blind even the medical experts to an extent of bending certain rules. Of course, there are other possible causes of ethical matters such as economic challenges that cause stress to the workers. Staff members in every health care institution ought to be trained on stress management and effective financial management. In the trainings, there must be emphasis on the consequences of unethical work relationships such as love affairs at work place. The employees of the medical center have to be aware of the importance of maintaining the corporate image of the institution. Causes of economic challenges are in two categories; preventable and unavoidable. Preventable causes are where people mismanage their resources and become poor to an extent that they cannot afford medical services (Lo & Groman, 2003). This can be avoided by emphasizing on work ethics and financial management skills including the practice of saving. The lifestyle of the staff members have to undergo paradigm shifts such that they can deny themselves unnecessary leisure o be able to take care of emergency medical situations among other needs. Unavoidable aspects of the economic challenges arise from external forces such as the rates of inflation, the market supply and demand of necessary commodities (Wagner et al., 1999). The trainings can expose the workers to the reality of economic challenges and the dire need to budget and prioritize on important matters. 5. Possible Solutions Out of the problems that have been identified through the study, there are possible solutions that can deal it them on a permanent basis. Apart from depending on the government subsidies to cater for economic problems, there is need for a self drive and proactive solutions for each individual. The major target group for this study is the poor people because the impacts of the problems affect them directly. Virtually all the challenges whether economic, ethical or legal, have serious effects on the quality of health services that these social classes can receive. The rich members of the society are safe because they have choices to make based on their resources and capability. What appears to be the driving force in formulating the framework for the solutions is the level of education of the target groups. As much as the medical practitioners require training, even the patients require community based trainings on personal empowerment and their legal constitutional rights as tax payers and citizens of a country. Until the point at which the people are stable, they require support from the government in form of financial support and provision of facilities. If all citizens are to enjoy equal rights, then it implies that medical facilities should be readily available to all without bias or prejudice. Governments must realize that once citizens have contributed to the national GDP through taxation, the government owes the citizens in terms of service provision. Health care is of course just one of them, and is interconnected with other vital services such as education and transportation. 6. Solution and its Implementation plan The road map for the implementation of the solution is as systematic as the series of activities listed below: 6.1. Integrating efficiency and Healthcare quality Majority of the of the challenges that face healthcare service centers will in the future depend on the ultimate challenge of integrating between the efficiency of services and the care system to the quality and safety, according to the recent studies from Hopkins University. The main question that the target group requires is whether their focus on healthcare services is being directed by the right values. The choice of the value is between the efficiency and the healthcare service quality. 6.2. Increasing the accessibility of Healthcare There should be a strategy to access affordable healthcare among all the citizens of a country. It remains to be a real issue to worry about, whether it is possible for all citizens to access the services or not. According to Philip of Duke University in the School of Medicine, the unavailability of these services is the main ethical issue of concern. Still other scholars suggest the dire need of implementing the reform laws of healthcare. There is at least a basic access of healthcare that can be availed to all citizens. 3. Increasing sustainable health care work force The future need for healthcare services indicates that there will be need to have a large number of healthcare professionals to care for the ever expanding population. The second indicator is the ever growing population of people with chronic terminal illnesses. The difficult question is whether the future professionals will indeed have the much needed patience, competence, compassion. Scholars wonder whether there will be professionals with a passion to perform healthcare work with sincere devotion. 4. Addressing terminal matters The other issue that is raised by the scholars from the Hastings Center is the terminal life issues that grow with the growing population. This brings to light the subjects of life insurances and the compensations that come at the end of life or when the policy bearer is approaching the old age. This addresses the matter of life expectancy and related critical decisions. 5. Controlling the allocation of medicines The next strategy is to minimize the release of medicine to control the supply and minimize wastage. What has been causing the shortage of medicines is the shortage of economic incentives. The system should be able to use the model and decide on the quantities of medicine released in the treatment centers. Food and medicine should be the most basic resources that a country provides to the citizen. Additionally, the scholars of ethics recognize that it is possible other new issues continue to emerge. A good example is the effects of healthcare technology on medical information, communication and patient confidentiality. 7. Justification These solutions are justifiable because they all integrate the issues of Ethics and quality of healthcare in the various health organizations. The two are both based on ethical principles which act as the fundamental base for quality. These solutions have described the synergy that exists between ethical principles and the improvement of value, quality and safety of the services. It has illustrated vividly how the healthcare staff members, quality development experts and ethics team members can use in the future in the application of quality development framework to expose and offer preventive measures against the ethics issues. References Bottrell, M. M. (2002). Practicing Policy Ethics: The Influence of Ethical Orientation on Policy Decision Making by State Nursing Home Surveyors. New York: New York University Press. Davidoff, F., & Batalden, P. (2005). Toward Stronger Evidence on Quality Improvement. Draft Publication Guidelines: The Beginning of a Consensus Project. Quality and Safety in Health Care, 14(5) (2005). Emanuel, L.L. (1996). A Professional Response to Demands for Accountability: Practical Recommendations Regarding Ethical Aspects of Patient Care. Working Group on Accountability. Annals of Internal Medicine, 124 (2). Freedman, B., Fuks, A., & Weijer, C. (1992). Demarcating Research and Treatment: A Systematic Approach for the Analysis of Ethics of Clinical Research. Clinical Research, 40. Kofke, W. H., & Rie, M.A. (2003). Research Ethics and Law of Healthcare System Quality Improvement: The Conflict of Cost Containment and Quality. Critical Care Medicine 31(3). Koschnitzke, L., McCracken, S.C., & Pranulis, M. (1992). Ethical Considerations for Quality Assurance versus Scientific Research. Western Journal of Nursing Research, 14 (3). Lo, B., & Groman, M. (2003). Oversight of Quality Improvement: Focusing on Benefits and Risks. Archives of Internal Medicine. Nerenz, D.R., Stoltz, P.K., & Jordan, J. (2003). Quality Improvement and the Need for IRB Review. Quality Management in Health Care, 12 (3). Peraino, R. A. (2002). Holding the Medical Staff Accountable for Quality Improvement. Trustee 55(9), 24–25. Wagner, C., Bakker, D., & Groenewegen, P.P. (1999). A Measuring Instrument for Evaluation of Quality Systems. International Journal for Quality in Health Care, 11(2) Read More