Health services are commonly rationed due to their perceived value, level of controllability, and the scarcity of health service resources

Health services are commonly rationed due to their perceived value, level of controllability, and the scarcity of health service resources

Health services are commonly rationed due to their perceived value, level of controllability, and the scarcity of health service resources 150 150 Peter

Identify a current strategy that the government uses to ration healthcare. Then, describe how this policy may influence your health services organization and explain how this policy impacts healthcare cost and access. Be specific and provide examples.

Challenge or support 2 of your colleagues’ perspectives with additional evidence.

Colleague 1

Health services are commonly rationed due to their perceived value, level of controllability, and the scarcity of health service resources (Keliddar et al., 2017). The goal is to get a fair level of equity across the populations while controlling costs (Keliddar et al., 2017). Some common ways the government can enact legislation to ration healthcare services is making it difficult to afford, such as placing restrictions on access to health insurance, customizing a more selective benefit design, or making patient cost-sharing unaffordable. Medicare and Medicaid recipients are subject to the rules and limitations of government legislation regarding their coverage. Some other countries ration healthcare services through long wait times or limitations on the types of drugs their universal coverage will cover (Tikkanen & Osborn, 2019).

This type of rationing impacts the cost of and access to care. Some levels of rationing are implemented as a cost-control mechanism, as opposed to an issue around scarcity. For example, some healthcare systems require you to try a similar, less expensive drug first before being granted coverage for a high-cost specialty medication (Scheunemann & White, 2011). For most patients, the lower costing option will work just fine. By switching patients over to the lower costing option, they have reduced overall health expenditure. Another example of how it affects patients can be found around access. Healthcare rationing can hinder access to care for many who cannot obtain coverage or cannot afford their portion of the cost-sharing. An example would be Medicare offering to cover skilled nursing for only a limited number of days per benefit period and only after the patient meets a laundry list of qualifying metrics (Centers for Medicare & Medicaid, n.d.). This limits patients’ access to the care they may rightfully need due to costs controlled by the government.

We all witnessed a different kind of healthcare rationing this past year. With the introduction of the Covid-19 pandemic, we saw health care rationing played out in full public view. The government rationed vaccines, providing a priority list while the stock was low. Local hospitals and care facilities rationed beds, supplies, PPE, even medication (Srnivas et al., 2021). This type of rationing greatly limited access to patients. Some people died waiting for beds, ventilators, and medications. We have deemed healthcare rationing as an inevitability, even in the U.S.. However, basic rules and regulations around protecting patients and their basic rights to life-sustaining healthcare should be enacted. Rationing is important to supply and priority, but it must be done in an equitable, just way.

References

Centers for Medicare & Medicaid. (n.d.). Medicare Coverage of Skilled Nursing Facility Care. https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf

Keliddar, I., Mosadeghrad, A. M., & Jafari -Sirizi, M. (2017). Rationing in health systems: A critical review. Medical Journal of the Islamic Republic of Iran, 31(1), 1–7. https://doi.org/10.14196/mjiri.31.47

Scheunemann, L. P., & White, D. B. (2011). The ethics and reality of rationing in medicine. Chest, 140(6), 1625-1632. https://doi.org/10.1378/chest.11-0622

Srinivas, G., Maanasa, R., Meenakshi, M., Adaikalam, J. M., Seshayyan, S., & Muthuvel, T. (2021). Ethical rationing of healthcare resources during COVID-19 outbreak: Review. Ethics, Medicine and Public Health, 16. https://doi.org/10.1016/j.jemep.2021.100633

Tikkanen, R. & Osborn. R. (2019). Does the United States Ration Health Care? The Commonwealth Fund. https://www.commonwealthfund.org/blog/2019/does-united-states-ration-health-care

Colleague 1

According to the Commonwealth Fund, the United States government rations healthcare by limiting access to comprehensive insurance coverage and affordable care (Tikkanen & Osborn, 2019). The very design of the American healthcare system is a form of rationing because of the way it is structured. Limiting insurance coverage, high premiums and out of pocket payments as well as limited access to some segments of the population are all forms of rationing healthcare. Ten years after the passing of the Affordable Care Act, (ACA) there are still about 30 million people in the United States without health insurance because they still do not have access to adequate insurance with affordable services and treatments (Tikkanen & Osborn, 2019).

A major concern about making the ACA law, was the potential for the law to create restricting barriers for some groups of the population. Managed Care is a current strategy the government uses to ration healthcare (Tikkanen & Osborn, 2019). The rationale behind managed care is that if we can control the care given then we can control cost. The government then encourages this by creating incentives for Accountable Care Organizations to managed care while controlling cost (Tikkanen & Osborn, 2019).

One form of rationing that is affecting my organization is copays and deductibles. Copays and deductibles add an additional barrier for some individuals seeking mental health care and medications. As we battle against this Covid-19 pandemic, and experiencing the far-reaching effects into our lives, the federal government can reduce this burden by removing all copays and deductibles to help level the plane field for those Americans who are experiencing financial or economic difficulties during this time (Ubel, 2020).

Reference:

Roosa Tikkanen and Robin Osborn, ( 2019). “Does the United States Ration Health Care?,” To the Point (blog), Commonwealth Fund, July 11, 2019. https://doi.org/10.26099/ke5j-bk81

Ubel, P. A. (2020, April 24). Charging Copays and Deductibles During a Pandemic Is Foolish–and Deadly / Opinion; Yes, the United States rations medical care by ability to pay. We can’t have that happen as we fight COVID-19. Newsweek, 174(11).