Ethics in Public Administration - Research Paper Example

ETHICS IN PUBLIC ADMINISTRATION-HEALTHCARE INTRODUCTION Quality healthcare is the fundamental feature that is provided by a true welfare state. It is important for the government of a welfare state to ensure that the people are provided with equal opportunities to avail health services. Not only that, the health care should be provided at an affordable rate so that every person, no matter what income group he/she belongs to, can avail the services. In the US, the authenticity of the healthcare system and its ability to live up to its purpose has been questioned for long. The expensive healthcare is only viable as long as the members of the society have an insurance policy backing their health needs. For many developed countries the public financed model of healthcare has worked tremendously well as it enables the provision of the same level of health care to the masses. For example in UK, the NHS (national health services) is a government run agency that is responsible for designing and implementing ways through which the government levied health tax pool can be utilized efficiently. This system makes it mandatory for every member of the population to pay the health tax in order to be eligible to benefit from free or minimal cost healthcare services. The healthcare services provided cover a variety of medical needs from clinical check-ups to maternity services etc. In the US however, the system of healthcare is different. They do not rely on public financing but on pay-as-you-need basis (Scu.edu, 2014). This has made the US healthcare system extremely costly for the masses (Berwick, Nolan & Whittington, 2008). The healthcare of the people has become a profiteering business and the providers charge what they please. This has increased the need for health insurance that is usually obtained as an employment feature. Americans have revealed a dire need for affordable healthcare that doesn’t have the insurance sword looming above their head. The aim of this paper is to identify the ethical implications and the fulfillment of social justice as far as the purpose of the US healthcare is concerned. SOCIAL JUSTICE Social justice is considered as the provision of justice to a whole set of people and not just individuals (Miller, 1999). Fair share of resources and human rights are some of the related concepts that highlight the justice aspect of a society. It is ascertained that every member of the society needs to be given his due rights and a fair share of the state run facilities. Thus, social justice is a wholesome concept that emphasizes on the need for the establishment of a system that supports and treats ever member equally. It helps in building a sense of unity and brotherhood amongst the people, reducing the disparity between the rich and the poor and creating an environment of peace. One of the basic rights of the society as a whole is being provided with opportunities to avail necessities like food, shelter and health at an affordable rate. Many countries that claim to be socially just have issues that depict loopholes like high rents, high property rates, food inflation etc. healthcare is an need of every person at one point in time and being a necessity it forces people to pay as much as it is being charged at. Countries with high healthcare costs are constantly criticized for not being a complete ‘welfare’ state and for not considering the needs of its people. United States has long been a center of debate for the same purpose as the health system in place is highly costly one and out of the reach of many of its people. THE ETHICS OF HEALTH Before discussing the ethics of health it is important that health is justified as an ethical need of the society. Part from enabling an individual to be at his efficient best and achieve his life objectives, health is one of the factors that contribute towards wellbeing. Every person is vulnerable to a health issue or problem and no one brings it upon himself deliberately. In these cases of unforeseen circumstances, a person needs security and mental satisfaction that he has coverage or will be facilitated within acceptable and affordable means. For the distribution of health to be just it’s imperative that it maximizes the average utility amongst the society’s inhabitants. ACCESS AND UTILIZATION OF HEALTHCARE: Healthcare includes all those factors that contribute towards improvement of individual and collective health of the society (Goel, 1995). Access to healthcare and the need for healthcare are two dimensions that highlight the ethical utility of healthcare (Hurley, 2001). It is however, not the access or need that justifies healthcare ethically but the access and utilization of the need that is sought by the people. The concept of need is clarified by many economists as the one that is effective in attaining an ethical legitimate demand of a person. The purpose of consuming healthcare is to improve one’s health and this creates the need for healthcare (Culyer & Wagstaff, 1993). Quite often the utility interdependencies of the members of the society determine the extent of the effectiveness of healthcare provision. Since the resources are scare the utility of one member is dependent upon the health status of the other. Limited resources can only be obtained and utilized by a limited number of people. Utilitarian or welfarist societies both associate effectiveness of just healthcare with the utility and need of healthcare and not just their ability to pay for it. PUBLIC FINANCING For the health resources to be distributed equally amongst the people at an affordable rate it is imperative that a public financing system is in place. This is because the members of the society contribute equally towards a healthcare pool enabling them to avail healthcare facilities at a uniform level when needed. Insurance for healthcare is a collective activity which involves a number of Individuals contributing to a risk pool as insurance premium in case they need healthcare. If one contributor to this pool falls ill, he can benefit from the collective pool hat is generated through the various participants. In such a system the market allocates the limited resources to the people who can afford to pay. Low-income segments of the market allocate their budgets within the prioritized needs. For them, health insurance is an added expense burden that can be avoided and looked at when the situation occurs. Thus, they are the ones who genuinely need the welfare support and lack of affordability makes it hard for them to avail healthcare facilities without health insurance. The effectiveness of public financing can only be judged by the extent of fair allocation of health resources. Allocative effectiveness is evaluated by considering production of the needed amount of healthcare and its distribution according to the value placed to them. This value could be generated by evaluating utility, well-being, heath status etc. Private healthcare insurance poses two kinds of inefficiencies that can be avoided by adopting a public financing system. Firstly, the fixed costs incurred by the insurance company disable them from sustaining the competiveness of a market with many players (Evans & Brown, 1984). Secondly, public insurance systems are free from the hefty administrative costs that multiple insurance providers incur. It is imperative to remember that many insurance companies are businesses and every business’s aim is to lessen risks and maximize profits. Thus, a number of insurance companies indulge in risk selection. This refers to selecting Individuals who are low-health risk and selecting individuals who are willing to buy generous insurance. This eliminates the inclusion of high-risk and low-profit members of the society like those who belong to low income segments. Public financing covers all the members of the society without considering their risk and profitability factor. The inefficiency level of private insurance healthcare is also high due to the fact that the people are likely to approach healthcare providers to diagnose their treatment and then select one out of the many options for treatment. This gives the health care providers the liberty to engage in unethical price hikes, unnecessary procedures etc. that not only set a high market cost level for health services but also create a supply side shortage. The inability to identify necessary and unnecessary health services create the opportunity for the providers to set high prices for both making it unaffordable for the low income households who are in greater need for healthcare. PUBLIC FINANCING WITHOUT PARALLEL PRIVATE FINANCING: Many countries of the world who have implemented the public financing system for healthcare allow a parallel private insurance option for people who can afford it. This allows the wealthy to avail a wider set of facilities, skip public queues, avail treatment privileges etc. This system was implemented as a result of the criticisms that public financing was unfair for the wealthy people as they have better health standards and avail less facilities however they are taxed the most. But allowing a parallel private financing system is likely to increase the disparity between the rich and poor which is not an aim of a true welfare state. Allowing such a system to prevail in parallel reduces the efficiency of the public health facilities, drain unnecessary resources, restrict timely access to a facility by each member, result in longer queues at the health centers and most importantly erode public support for a healthcare system that allows the wealthy of the society to enjoy extra amenities just because they can afford it (Macdonald, 1998). An ethical and just society does not allow such privileges for basic necessities aimed at benefiting all, thus the proposed system is one without a parallel private financing one. CONCLUSION In order to have justice prevail at all levels of the society it is imperative that the private insurance healthcare system be replaced by a single payer public financing one. The consequences of insurance based health care will leave majority of the masses either with less insurance coverage due to the high healthcare prices or no insurance at all due to the factor of affordability. Public financing ensures universal coverage etc. all at an equal rate. The utility derived from a public financed health insurance has to be weighed against the welfare cost of insurance and risk preferences under the private financing system. By providing everyone the same chance at insurance the likelihood is that the ones benefitting would be those who are under disadvantage under the insurance healthcare. Health oriented welfare is only possible if equal opportunities to improve the health of the low income status groups are provided. Having a sole authority that is responsible for funding, allocation and delivery of service will enable the resources to be allocated effectively to benefit the most number of people. It will help in de-commoditizing healthcare and improving the affordability aspect. Public financing supports re-distribution of wealth in a society by levying higher healthcare tax on individuals who can afford it and allowing the low income groups to benefit equally from the generated pool (Breslow, 2002). In this way, wealth is more effectively distributed in terms of facilities to the people who need it the most. REFERENCES: MacDonald P, Shortt S, Sanmartin C, Barer M, Lewis S, Sheps S. Waiting lists and waiting times for heatlh care in Canada: more management!! More money?? Ottawa: Health Canada, 1998. Breslow, L. (2002). Encyclopedia of public health (1st ed.). New York: Macmillan Reference. Culyer, A., & Wagstaff, A. (1993). Equity and equality in health and health care. Journal Of Health Economics, 12(4), 431--457. Evans, R., & Brown, M. (1984). Strained mercy: the economics of Canadian health care. Butterworths And Company. Goel, V. (1995). Why are Some People Healthy and Others Not? The Determinants of Health of Populations. CMAJ: Canadian Medical Association Journal, 152(12), 2004. Hurley, J. (2001). Ethics, economics, and public financing of health care. Journal Of Medical Ethics, 27(4), 234-239. doi:10.1136/jme.27.4.234 Miller, D. (1999). Principles of social justice (1st ed.). Cambridge, Mass.: Harvard University Press. Scu.edu,. (2014). Health Care Reform and Social Justice. Retrieved 23 June 2014, from http://www.scu.edu/ethics/practicing/focusareas/medical/health-care-reform.html Berwick, D., Nolan, T., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), 759--769. Read More