Equal Healthcare Distribution - Essay Example

Equal Healthcare Distribution s 27th March Equal Healthcare Distribution Compared with other nations, the United s spends more resources on healthcare than any other country in the world (Trotochaud, 2006). In the United States, health care costs have been on the rise since the 1960s. The increase in costs has occurred at a rate in excess of economic growth or inflation rates. In the late 1990s, efforts were placed with the primary aim of increasing emphasis on the market forces. On the other hand, the forces have created an avenue or incentives to alter the United States health care structure as one way of containing costs. Even after increased spending on the United States health care, the country could not manage to improve health status significantly. Currently, access to health care in the United States is far from equitable; this has raised the legitimate question of justice. Health care insurance has managed to obtain access for most Americans, but 15 percent of individuals remain without coverage. A lot of people are still not able to access modern medicine, and this raises an important topic in medical ethics (Trotochaud, 2006). Access to Healthcare In the conceptual bioethics framework, access to health care is under the principle of justice, for example; entitlement to resources, equitable distribution, and fairness. The issues of justice in the health care system are divided into two related but different dimensions; access and allocation. Allocation is the process that is used to determine the health care resources for distribution to individuals and populations. The allocation issue has three levels; social level, this is the amount of resources spent by the government on health care compared with other budgetary needs. Second tier is allocation at the point of healthcare service; this is the decisions of health care portions of the federal budget and to whom, where and how the funds will be spent. The final level concerns the individual patient; access to health care in the United States is determined by the ability to have health insurance coverage. Access relates to whether individuals who should be or who are entitled to access health care services can receive them. Even with all the government spending on health care, a majority of people in the United States go without health insurance coverage (Trotochaud, 2006). For example, in the year 2009, 50.7 million individuals lacked healthcare cover. For the many individuals covered by insurance, they can access high-quality care with ease but at high costs. Those without coverage, or without adequate cover forgo much-needed care, suffer from preventable illnesses, and avoidable complications due to lack of early detection and treatment. Such people suffer from financial difficulties due to high medical debts and even premature deaths (Trotochaud, 2006). Reasons behind the lack of Equal Distribution Poverty is the largest factor contributing to a lack of insurance coverage. More than thirty percent of people at or below the poverty level have no insurance coverage. Decision-making tactics that result in access to health services are also a leading factor since most are inequitable and unjustifiable. Disparities are evident among racial groups in regards to health access, black Americans and Hispanics are the worst affected with 20 percent and 32 percent respectively lacking coverage. Gender also plays a role in the risk of having no health insurance cover, more men than women go without health insurance cover. Health care resources are often spent on resources that are harmful and of little benefit. Use of health care resources varies across the divide; studies have revealed that access to quality care and patient satisfaction is low in areas spending more resources (Trotochaud, 2006). In the United States, the health workforce is properly trained but distribution of the workforce is the issue. There exist too many physicians in some specialties and far too few in others especially in aspects of internal medicine and primary care. There are not enough primary care workers to meet the aging populations needs. Also, there exist clear disparities in the distribution of doctors and other health professionals geographically. Rural areas are poorly represented while urban areas are over-represented. In the United States, up until 2011 there was no national workforce policy for coming up with requirements and ensure the supply and distribution of well-trained personnel (Trotochaud, 2006). This is an avenue that the American College of Physicians aimed to address with the creation of a national advisory commission that would report to Congress. According to Trotochaud (2006), “the commissions started working in October 2010 and have been successful in providing data on projected and current trends in the health sector. Also, they offer recommendations and training of health care workforce”. Private spending on health insurance affects the amount of available resources for other purposes; this determines the level of accessing health care services. In the United States, private insurance is subsidized by taxpayers, either by direct subsidies or through tax exemption for employer-sponsored insurance. Therefore, steps should be taken to encourage proper use of privately funded health resources. Health care takes a lot of private resources, and this might result in fewer resources for other vital needs. Private health care resources should be spent wisely, not on ineffective or inappropriate medical services. Steps must, therefore, be taken to ensure that American citizens obtain much-needed health care. Distributive Justice The principle of justice requires that everyone should have an equal opportunity to access resources. In health care terms, individuals should receive services and care that each is due. In instances where individuals needs and interests conflicts with those of the public, providers within the organization are more likely to represent the demands and interests of a person under their care. Therefore, the decision of enforcing and interpreting rules in regards to the decisions of allocating and denying resources rests with managers and policy makers. Due to the difficulty and contentiousness of these issues, a-six criteria have been developed to inform allocation decisions. They are; need, contribution, equality, ability to pay and merit (“Administrative Ethics,” 1998). Need is an important criterion since most patients involve a known health condition for treatment. Complications may arise since individuals understand need differently that their health providers. When providers choose an individual, the justification of need may become conflicted. Need may lead to the depletion of health resources leading to adverse consequences. The equity concept is useful and relevant, but it fails to work in line with health services. In any society, there exists a wide range of demand from people who need few health care services to those requiring continuous life considerations. In the United States, the routine procedure should not support health care denial because the costs or number of services have gone above predetermined quotas. Resource allocation should never be based on reimbursement policy. Medicare and Medicaid have contributed to unequal distribution of health resources by using a limited payment liability. They limit coverage to a maximum and fail to cover specific services based on a predetermined dollar limit (“Administrative Ethics,” 1998). On the other hand, contribution determines what a certain individual might give to the society in the future. It works against poor people. Ability to pay; denying health care services based on the capacity to pay is against the belief of charitableness and generosity evident in the U.S. Ability to pay; considered in programs such as Medicaid and Medicare. Patient effort; this is whereby patients who have shown a high degree of observing medical advice are given an individual priority. It is reasonable to spend more resources on people who help themselves, but it might not work for children and mentally challenged people. Merit; this is the best criteria for making health care resource allocation decisions. But, it might be hampered by conflicting sources of data (“Administrative Ethics,” 1998). Rationing as a Solution Rationing means to use sparingly and distribute equitably. In medical terms, rationing is planning for the equitable allocation, apportionment and distribution of health care services. According to many, rationing, relates to delays in treatment, interference by government bureaucrats and long waiting lines. Those against this strategy claim that those at the top of decision-making will have more power than they need. They also state that it might lead to undervaluing the lives of the disabled and elderly and impose restrictions towards physicians to provide individualized care. According to the ACP, the government should move from the term "ration" and focus on developing a consensus on decision-making and equal healthcare service delivery (American College of Physicians, 2011). Decisions must be made to come up with better ways of allocating resources. More spending should not be the central point; they should ensure that services remain necessary and safe. Proper healthcare should not prevent others from obtaining beneficial care. Resources should be allocated in ways that control costs and save money. Improvements should also be made in the decision-making processes that are currently uncoordinated and irrational. Limits in accessing health care are prevalent due to price of services, eligibility requirements, health insurance status and the distribution of health care professionals. If these mechanisms remain uncoordinated, it will result to further disparities in the quality and access to healthcare (American College of Physicians, 2011). Under rationing, there exist many forms of rationing. They are; supply based rationing, this is prioritizing access to a service like liver transplants due to the limited supply of livers available for transplantation. Another type of rationing is cost-based rationing; these are decisions about providing or not offering expensive care. Incremental rationing; they occur when a new drug or technology is in the market, doctors check whether if the drug or technology is beneficial to the patients. Public rationing; decisions made on the use of public resources for the benefit of the public. Rationing is not without controversy; for example, age-based rationing where health care services are limited to people within a particular age group. Under this form of rationing, the elderly are given less priority. It has presented severe political, moral and practical dilemmas (Trotochaud, 2006). In conclusion, the United States is the nation that spends more of its resources on healthcare. Even with all the money, the health sector did not perform to expectations. It has given rise to many challenges like unequal distribution of health care. Fifteen percent of American citizens are without medical cover, and this number cannot go unnoticed. The government should take care of the poor people to improve the number of those covered by health insurance. Equal distribution of health professionals will go a long way in ensuring equity in health services access. The government and all stakeholders should employ and improve distributive justice aspects to cater equally for everyone without favor. Rationing, that occurs in many countries should also be considered, and the contentious aspects improved upon to serve the population. The American government should also study other countries that have successful health systems and note the areas that need improving. The governments primary goal should be to improve the health of the citizens. Secondly, patients should be adequately informed of allocations and their justifications. The government should also ensure that citizens can consent to allocation decisions that are directly or indirectly affecting them. Finally, the ones in power should make decisions without any conflict of interest. On the other hand, citizens and healthcare professionals should study current trends to note areas that need improving. References American College of Physicians. (2011, March 13). Retrieved from http://www.acponline.org/advocacy/current_policy_papers/assets/health_care_resources.pdf Administrative Ethics and the Allocation of Scarce Resources. (1998. March 13). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol31998/No3Dec1998/ScarceResources.html Trotochaud, K. (2006). Ethical Issues and Access to Healthcare. Journal Of Infusion Nursing, 29(3), 165-171. doi:10.1097/00129804-200605000-00007 Read More