A Case Against the Policies of Restrictions on Access to Health Services - Essay Example

Your name:   Course name:         Professors’ name: Date: Healthcare Policy is one of Country’s most controversial topics and has been a major issue at every election since the 1940’s. The main reason for disagreement is that major health stakeholders have conflicting and different interests. Healthcare providers want high incomes and profits, consumers want access to different health services at affordable price. While the government wants to control the funds they spend in health services. Johnstone (2009) argues that access to healthcare is a controversial and a complex, and sensitive moral issue (p.136). Johnstone (2009) goes further to state that there are some barriers to access of healthcare services that are put in place intentionally by healthcare services such as the governments or organizations. The issue of healthcare access is fraught and broad with political, economic, legal, medical, technological and social difficulties; this is according to Starfield (2007). This paper will support these policies that increase access to healthcare services on ethical grounds. The health expenditure in Australia is still reliant on the people’s expenditure despite efforts being made by the Australian government. According to the Ministry of Health, expenditure has been a major barrier in accessing healthcare services in both private and public health facilities. In the past, close to 60 per cent of Australians do not seek health services because of high cost, with some many Australians were going for non-conventional methods of treatment. Currently, the government has been able to reduce high cost of treatment and improve access to quality health services to the poor. Ironically, poverty among the poor Australians may sometimes mean improved access to some healthcare services and no access to others. For example, many government funded policies and programs increase access to cervical- and breast- cancer diagnosis for poor women in Australia, which is beneficial except that these policies and programs set by the government forces poor people to struggle on means on how they can be able to obtain treatment for those women diagnosed. Inability for Australians to afford comprehensive coverage is one of the barriers to access of healthcare services, although this issue cannot be defined solely by social-economics factors. Many Australians who have health insurance remain underserved with respect to cancer detection, prevention and treatment. In 2010, the Cancer Council Australia identified several such groups in addition to the poor: “persons with disabilities; the elderly in the society who have limited literacy, education, or language ability and those people such as indigenous people whose cultural practices and beliefs may pose barriers to using western bio-medical methods or techniques” The problem with health services subsidies is that they are levied at a flat rate, taking no account for the poor person’s ability to pay. These payments has created hardship for poor persons or low income earners and this has created financial barriers to access of health services, defeating the purpose in which the Australia’s government get involved in healthcare systems. The privatization policies that were started by the Howard’s government, particularly the 30 percent funded private insurance have been strongly criticized in many quarters. There are serious concerns that have faced the Australian health services in the long-term. The first problem with health services subsidies is the impact of user charges, this means that people in Australia who earn low incomes continue to use fewer health services than they need. The second concern is the healthcare inflation, which has been projected to grow. In healthcare inflation, the government always is responding in shifting the costs onto consumers, in the form of user charges, further increasing the barrier of health services. Third, concerns that have been expressed by experts including Royal Australian College of Physicians about the workability of the Pharmaceutical Benefits Scheme, which is an important building block of the health services system, which experts have argued that the system has been undermined by the free-trade agreement with the U.S. In 2008, WHO (World Health Organization) found that 65.4 per cent of Australian adults are overweight, ranking 20th in the world. While a study conducted in 2005 by WHO found that 20 per cent of Australians adults were obese (Lauren, 2008). This figure is expected to rise to 30 per cent in 2010 if the current trends remain the same. As a result of these shocking statistics, the Australian government formulated a policy whereby overweight members of the society must seek treatment at hospitals that are designated as suitable to care to patients of such weight (McGinley and Bunke, 2008). This policy has not increased access to health services for overweight patients in the country because providing clinical care for overweight patients in the health facilities setting can require new policies and procedures, extra staff, and special equipment, which most health facilities in the country are afraid of investing in these new requirements. An overweight person is proven to have a higher prevalence of limiting longstanding sickness. That person is more likely to be admitted into a healthcare facility and he may require specialist equipment for safe management (Sturm, 2007). However, most hospitals in Australia are ill equipped to provide healthcare services for severely overweight people. Evident from the Australia suggests that this is becoming medicolegal issue and clinical risk as severely obese patients may receive suboptimal treatment and medical personnel such as nurses and doctors can sustain injury when attempt to mobilize severely obese patients. The existence of a bariatric policy in Australia’s health facilities does not necessarily equate to implementation and this paper demonstrates that equipments and tools for dignified and safe care of the overweight patient is not always readily available where it is needed. Without large beds, operating table, heavy-duty wheelchairs and other equipment, obese patient safety may be compromised. Studies from the Australia report cases of injury to overweight patients when examination wheelchair or trolleys collapse or other equipment fails provision of expensive equipment such as MRI scanners or CT sufficient for the care of morbidly overweight patients requires long-term planning for each healthcare facility (Kuriyama, 2006). In Queensland, obese patients weighing over 222kg/35 stone could only access proper imaging equipment in 5 per cent of hospitals. Failure by most hospital to provide required imaging equipment may lead to inappropriate surgery or delayed in diagnosis- and, occasionally, potential use of zoological or veterinary scanners, with resultant loss of dignity for the overweight patient. Once again, data from the Australia suggest that obese patients are becoming aware of this inequality of access to health services such as imaging due to their big size. In the country, Radiology departments in different hospitals are aware that they are under-equipped to deal the growing overweight epidemic. But, most of these hospitals have cited that they are still faced with many challenges such as the cost of upgrading their existing equipment to be extremely high. Despite this, only 20 per cent of theatre departments had a specific policy for the care of bariatric or obese patients in theatres (Kuriyama, 2006). Johns Hopkins researchers conducted a study that involved 40 primary care doctors and 300 of their patients. The study found that there is less rapport between physicians with their obese and overweight patients than with their patients who are not overweight or obese. Empathy and bonding are important to the physician-patient relationship. When doctors or nurses express more empathy towards a patient, studies have shown that patients are more likely to respond to behavior-change counseling and adhere to medical recommendations. All are important elements in helping obese and overweight patients improve health and lose weight. It has been found that most of these special built facilities for the overweight patients aren’t establishing a good rapport with overweight patients, thus overweight patients have been found to be less likely to adhere to their doctors recommendations to lose weights and change their lifestyles. The study found that patient weight played no role in the quantity of doctors’ medical advice, counseling, medical questions, or treatment regimen discussions. But when it came to things like showing concerns, empathy and understanding, physicians were more likely to express those behaviors to patients who have normal weight than obese and overweight patients, regardless of the topic being discussed (Wolf, 2006). Overweight or obese patients are found to be vulnerable to poorer patient-physician communications, Kaminsky and Gadaleta (2010) says, because researches show that doctors may hold negative attitudes toward overweight or obese patients. Some doctors have been found to have less respect or no respect at all for their obese or overweight patients, which may come across during patient treatment (Larson and Fleishman, 2006). Many doctors and nurses are uncomfortable interacting with patients whose culture, language, socioeconomic status, and sexual orientation are different from their own. Because physicians may claim prerogative of preselecting the patient populations they will serve, diminished access to care for overweight or obese people may result. About one in six Australians lives in a rural area. Compared with their urban counterparts, rural people are more likely to be overweight or obese, be poor and be older, be in poor health or be fair, and have chronic conditions (Adler and Newman, 2010). As compared to their urban counterpart, rural people are less likely to receive recommended health services and on average report fewer visits to healthcare facilities. Although about 20 per cent of Australians lives in rural areas, only 10 per cent of doctors in Australia practice in those areas (Kaminsky and Gadaleta, 2010). Transportation needs are pronounced among overweight or obese patients, who must travel longer distances to reach special hospitals catered for this group. On the nearly 1,000 frontier counties in the country, most of hospitals have limited healthcare services and many of these hospitals do not have facilities used to treat overweight or obese patients. In rural areas patients are required to travel long distance to access health services. In addition, healthcare facilities in these areas are underequipped and often provide limited services. According to Value Statement 1; nurses are required to respect culture, dignity, beliefs and values of patients (Australian Nursing Council Incorporated, 1993). In other words, nurses are required to protect and promote the interests of a patient irrespective of age, gender, sexuality, and race, cultural or religious beliefs (Lauren, 2008). But as more Australians become obese or overweight in the society, Instances of weight discrimination has continued to be reported in multiple health services. Of particular concern is when these cases of discrimination concern denying obese or overweight patients health services because of their excess body weight (Kuriyama, 2006). For example, a woman in Sydney was turned away from her physician because of her excessive weight. In Australia, it is not illegal for a hospital to have such a policy. Every year, thousands of doctors and nurses take the Hippocratic Oath to pledge their commitment to patient care. But this commitment is not extended to more than 21 per cent of Australian adults and 7 per cent of teenagers who are considered to be obese or overweight. To some extent, obesity is more common among the low socio-economic groups, Torres Strait Islander and Aboriginal and rural women. This goes against Value Statement 5 of Code of Ethics for Nurses that nurses are supposed to fulfill the responsibility and accountability of their roles. In 2001, it was reported that 10 per cent of Australian hospitals were denying surgeries to smokers. This policy has been supported by an article in the British Medical Journal stating that smokers should be refused elective surgery unless they stop smoking for at least 30 days. A similar policy has been reported in place for overweight and obese people who are required to lose weight before undergoing certain surgeries (Kuriyama, 2006). This policy is against Value Statement 6 of Code of Ethics for Nurse that requires nurses to promote health and well being of a patient. The number of overweight and obese patients in Australia keeps growing, and these physicians are terrified that they’re not well equipped to handle obese patients. But the way to protect their practices isn’t shutting out patients who need their care. A good physician would learn ways of protecting these high-risk patients. Read More