WEEK TWO: THE ETHICAL IMPACT OF HEATLHCARE POLICY & THE ROLE OF ETHICS IN POLICY DECISION-MAKING

Impact of Healthcare Policy on Health

Public policies that influence health or the inquiry of health are considered health policies (Longest, 2010). Health policy is defined as “authoritative decisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others” (Longest, 2010, p.5). Health policy is one of the effective tools to improve health (Healthy People 2020, 2014). Health polices can affect individual and community health in a positive way (Longest, 2014).

Inappropriate Use of Emergency Department (ED) Visits and Health Policy

Statistics show that, if patients took advantage of primary care which focuses on disease prevention and health promotion, more than $18 billion could be saved from avoidable or non-urgent ED visits (Fay, 2019). In 2018, $3.65 trillion was spent on emergency treatment (Fay, 2019). As a result, there were more than 75 million people who ended up with medical debt, which is the number one cause of bankruptcy in the U.S. (Fay, 2019). Due to the high cost of ED treatment, some health insurance companies proposed an “avoidable ER (emergency room) policy,” which deny coverage if the ED discharge diagnosis is non-emergent (Chou, Gondi, & Baker 2018).

Role of Ethics in Decision Making Regarding Reducing Inappropriate Use of ED Visits

The role of ethics is very important in policy decision making and ethical considerations shape and guide the development of policies (Longest, 2010). One of the elements of ethics is beneficence, which is to do good to the public (Longest, 2010). Therefore, when a policy is made, participants in the process must act with charity and kindness (Longest, 2010). In order to reduce the inappropriate use of ED visits, Anthem Inc, a large national insurer has adopted the “avoidable ER policy” in 2017. In March 2018, U.S. Senators Ben Cardin (D-Md.) and Claire McCaskill (D-Mo.) were calling on Health and Human Secretary (HHS) Alex Azar and Labor Secretary Alexander Acosta to investigate Anthem for potential violations of the Prudent Layperson Standard (Ben Cardin, 2018). Dr. Friedman, the President of the American College of Emergency Physicians (ACEP) in Newsweek.com, has mentioned that “avoidable ER policy” is a dangerous insurer policy which could cause patients to gamble with their lives by self-diagnosing (2019). In addition, ACEP has filed a lawsuit against Anthem Inc. in Georgia to stop the policy that threatens the health of individuals and communities (Friedman, 2019). Policies should be made with the purpose of bringing good to the public. It is important to provide education to patients to utilize urgent care and primary care for non-urgent conditions. However, the “avoidable ER policy” could potentially threaten lives of patients (Friedman, 2019). Therefore, this policy should be banned. 

References

Ben Cardin-U.S. Senator for Maryland. (2018). Cardin, McCaskill Call on HHS, DoL to Uphold Prudent Layperson Standards for Emergency Room Health Coverage. Retrieved from: https://www.cardin.senate.gov/newsroom/press/release/cardin-mccaskill-call-on-hhs-dol-to-uphold-prudent-layperson-standards-for-emergency-room-health-coverage

Chou, S., Gondi, S., & Baker O. (2018). Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses. JAMA Netw Open, 1 (6):e183731. doi:10.1001/jamanetworkopen.2018.3731

Fay, B. (2019). Emergency Rooms vs. Urgent Care Centers. America’s Debt Help Organization.  Retrieved from https://www.debt.org/medical/emergency-room-urgent-care-costs/

Friedman, V. (2019). Insurers are forcing emergency patients to gamble with their lives by self-diagnosing/opinion. Retrieved from https://www.newsweek.com/insurance-emergency-self-diagnose-patients-doctors-1320569

Healthy People 2020. (2014). Law and Health Policy. Retrieved from https://www.healthypeople.gov/2020/law-and-health-policy

Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.