Health Care Law and Ethics

1
Health Care Law and Ethics
2
The Nature of Medical Practice

• Is the delivery and purchase of health care like
  other products?
• Consider the 7 misconceptions relating to health
  care highlighted on page 9
• Consider the following possible parallels. Whats
  wrong with them?
• Broken carssick bodies
• Diagnosis and repairdiagnosis and treatment
• Customer satisfaction-informed consent

3
The Nature of Medical Practice

• What prompts patients to seek treatment?
• What do patients expect from their health care
  professional?

4
Expectations of Patients and Doctors

• Patients expect their doctor to be
• Trustworthy
• Loyal
• Helpful
• Friendly
• Courteous
• Kind

• Doctors expect their patients to be
• Obedient
• Cheerful
• Thrifty
• Brave
• Clean
• Reverent

5
The Nature of Medical Practice

• Are these expectations realistic?
• Should patients be warned at the outset about the
  limits of medical treatment?
• What social significance attaches to a medical
  diagnosis?
• To what extent is there variability in medical
  decision making, and what are the implications of
  this?

6
Health Care Financing and Delivery

• Who are the principal players in the US
  Healthcare delivery system?
• Patient
• Physician
• Hospitals and other health care institutions
  (increasingly nursing homes)
• Employer
• Insurer and other payors (HMOs)
• Federal and state governments

7
Health Care Expenditures in Dollars (Billions)
8
Health Care Expenditures in of GDP
9
Health Care Expenditures in Per Capita
10
Health Care Financing and Delivery

• Physicians
• Highly respected profession
• Highly compensated profession
• Highly specialized profession
• Traditionally a highly autonomous profession

11
Health Care Financing and Delivery

• Hospitals
• Originally for the sick-poor
• Often formed by religious organizations
• Historically, non-profits dominated
• Rise of the for profit hospital
• Relationship to physicians
• Employees (typically residents, pathologists,
  radiologists, emergency room physicians)
• The Medical Staff

12
Health Care Financing and Delivery

• Employers
• Pay premiums (subsidize premiums) to indemnity
  insurers
• Self-insured
• Erisa

13
Health Care Financing and Delivery

• Private insurers
• Blues
• Community rating
• Commercial insurers
• Experience rating
• Public payors
• Medicare
• Medicaid

14
Health Care Financing and Delivery

• Fee for service
• Reimbursement for whatever is ordered
• Managed Care (HMO, PPO, HPO)
• Capitation or other financial incentives
• Gate keeping
• Prospective utilization review

15
Health Care Financing and Delivery

• Medicare
• gt65
• ltgt65 Kidney Dialysis/Transplant
• Medicaid
• Federal/State Program
• ADC
• Other needing (elderly)
• Broader plan design
• Pharmacy
• Nursing Home Care

16
Moral, Economic and Political Themes

• Should health care be a universal right in the
  United States?
• Should health care be rationed?
• Is it currently rationed?
• How should we decide who gets the rationed health
  care?

17
Moral, Economic and Political Themes

• Should the health care delivery system be largely
  run by
• The government
• The medical professions
• The insurance industry
• Employers
• Would a health-care systems design differ
  depending upon who ran it?