Vital things affecting the healthcare sector

Identify and describe at least two competing needs impacting your selected healthcare issue/stressor:

Two main vital thingsaffect the healthcare sector. The two components, in this case, contributes towards the evolving physician reimbursement structures. The two elements, in this case, include the ability of the different medical practice to come up with a better treatment for the ailing patients, and they need to be covered by the change physician reimbursement model (Häkkinen &Joumard, 2007).  The second component is the ability of the patients being able to receive better care than resolves their problem. On most occasions, it is considered changes in the reimbursement structure that makes the patients incur large bills where they believe that the procedural covered their bills.  Many times, this is the result of elements of a procedure being provided by an “out of network” provider, and often the patient lacks a clear understanding of precisely what that means.  Medical practices meanwhile, have a duty to provide a transparent service to the patient while running a business is based on these evolving reimbursement models. It remains one of the principal issues of healthcare in America, and is one of the reasons why healthcare in America is the most expensive of any country in the world.

Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor:


We have a system in our organization that a patient cannot be ‘coached’ on the reason they are requesting a particular procedure.  This policy may influence the issue of evolving physician reimbursement structures since the change from fee-for-service toward a merit-based model could potentially mean that a patient who is being seen for a particular treatment such as breast reduction might be covered under the new reimbursement model if the reason for surgery is back or neck pain, but not for cosmetic purposes (Li et al. 2009).   If our current policy remains in effect, the patient may be turned away if they provide an aesthetic reason for wanting breast reduction surgery while expecting that it will be covered under insurance.


Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.


The ‘no-coaching’ policy originates from an ethical perspective.  Apparently, in the past, we had patients complain that they had been “talked into” specific procedures by the Intake Specialist in our office.  Some of those complaints resulted in lawsuits.  For that reason, the policy was put into effect to guarantee that each patient received only the care and treatment for which they originally came in for and nothing else (Kivisaari, Lovio & Väyrynen, 2004).  The strengths of this policy are clear and have successfully eliminated the occurrence of patients complaining about being ‘sold’ on different procedures.  The challenges of our system are predictable, both financial and physical.  If a patient requests a method for a reason not covered under the continually evolving reimbursement model, we incur a negative patient perception by having to tell them the cost will not be covered by insurance. It inevitably leads to negative patient perception of our medical practice.  On the other hand, if we modified (or eliminated) this ‘no coaching’ policy, our Intake Specialist would be free to explain under what circumstances a procedure like breast reduction would be covered by insurance; allowing the patient to choose for themselves if they also have neck and back pain in addition to wanting smaller breasts for cosmetic reasons.  The moral support for a ‘no coaching’ policy is easy to understand; however, when it leads to a patient not receiving treatment that improves their health and wellbeing, the ethical results of such a policy can be called into question.


Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.


My recommendation is to develop material for patients that is specific to the most common procedures done in our practice.  This material would outline for the patient under what circumstances these procedures are covered by medical insurance and what circumstances they are not.  In most cases, methods for cosmetic purposes are considered ‘elective surgery’ by insurance companies and are therefore not covered by the insured policy.  Patients would receive this material upon first inquiry to our practice and would be told that reading the article could potentially mean the difference between receiving treatment covered by their insurance or not.  Patients for whom coverage is a primary element in their payment plan will likely read the material and come in for their consultation aware of the covered reasons that they can request a particular procedure.  There will always be patients who don’t care whether a system is covered by insurance or not, and they will likely not read the material.  Either way, our policy of ‘no coaching’ can remain in effect to protect the ethical foundation of our medical practice. At the same time, we take the additional step to educate the patient about their options.



Cite evidence that informs the healthcare issue/stressor and the policies, and provide two scholarly resources in support of your system or practice recommendation


A study entitled “Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them?”Was done by authors David Hansberry, Nitin Agarwal, Elizabeth John, Ann John, Prateek Agarwal, James Reynolds, and Stephen Baker.  In it, the authors analyze the efficacy of patient education materials across a spectrum of medical specialties such as endocrinology, allergy, and immunology, geriatrics, infectious disease, and cardiology, among others.  The evidence presented in the study of 540 articles determined that while providing educational material to patients was universally helpful and beneficial, the primary factor in whether patients understood the content was based on what grade level the literature was developed for.  Collectively, the medical research analyzed was written at an 11th grade or higher level – probably because the medical field requires a high level of education, and it’s these same practitioners that are developing most of the educational material.  The disconnect is that most people read at an 8th-grade level – and the AMA requires the article to be written at a 3rd to 7th-grade level.  As is usually the case, evidence to support policy may include additional elements to inform the policy development, and in this case, creating patient education materials will only be effective if it’s written in language everyone can understand.


In another article entitled “Improving Health Literacy?  The New American Thoracic Society Guidelines for Patient Education Materials” by Christopher G. Slatore, Hrishikesh S. Kulkarni, Judy Corn, and Marianna Sock rider the subject of patient education material development is explored in detail.  This article cites several examples of organizations and institutions that have recognized the critical role health literacy plays in facilitating and improving patient-centered outcomes.  Organizations such as the U.S. Dept of Health and Human Services, the Institute of Medicine, and the joint Commission have all called for comprehensive strategies to improve health literacy and patient-centered communication.  This article also identifies the challenge that many people lack the necessary health literacy skills, which leads to a host of poor outcomes (Meerding et al. 1998).  To make patient education materials more active, the ATS (American Thoracic Society) has developed guidelines for the preparation of ATS-sponsored patient education materials for medical practices to follow.  In general, their guidelines reflect many of the same recommendations that other medical specialties have developed, which all tie in with the AMA guidelines associated with patient education material.


Häkkinen, U., & Joumard, I. (2007). Cross-country analysis of efficiency in OECD health care sectors.

Li, L. C., Grimshaw, J. M., Nielsen, C., Judd, M., Coyte, P. C., & Graham, I. D. (2009). Use of communities of practice in business and health care sectors: a systematic review. Implementation Science4(1), 27.

Kivisaari, S., Lovio, R., & Väyrynen, E. (2004). Managing experiments for the transition. Examples of societal embedding in energy and health care sectors. System innovation and the transition to sustainability: Theory, evidence and policy, 223-250.

Meerding, W. J., Bonnieux, L., Polder, J. J., Koopmanschap, M. A., & van der Maas, P. J. (1998). Demographic and epidemiological determinants of healthcare costs in the Netherlands: cost of illness study. Bmj317(7151), 111-115.

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