Read the the case study “Economic Impact of States Declining Medicaid Expansion” page 305 of the Milstead text. Review the information in the Washington Post article “Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” in the Learning Resources. Consider how policy decisions currently are made about what will and will not be paid for and what changes, if any, could improve the process. Reflect on how the Washington Post example illustrates the tension between cost and care.

The U.S. healthcare delivery system is dependent on policy decisions. These policies determine which types of care will be covered by private and public insurers. These policy decisions are influenced by the tension between care and cost. The case study by Milstead (2016) titled “Economic Impact of States Declining Medicaid Expansion” shows how policy decisions affect health care financing. Author reveals how the unwillingness of certain states to expand Medicaid coverage in accordance with the Affordable Care Act caused many low-income people to become uninsured. This led to high uncompensated healthcare costs for hospitals.

In the Washington Post article “Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate,” it is apparent that there is a growing concern about the high cost of medical treatments (Brown, 2010). Provenge is a brand new treatment for prostate cancer. However, it was approved and not covered under Medicare. Provenge, a new drug for prostate cancer treatment was approved by the Food and Drug Administration. However, Medicare did not cover it because the cost of the drug was prohibitive and there wasn’t enough evidence to support its price. It demonstrates the way policymakers weigh the benefits and ethical implications of medical treatments.

Patients, providers of care, insurance companies, policymakers, and insurers all have competing interests. The result is tension between care and cost. Patients and providers desire the highest quality care, but insurers and policymakers want to limit costs. Dubois, Singh, and others (2017) state that the ethical issues surrounding policy decisions regarding health care financing are distributive justice, accessibility, and provider obligations. These stakeholders’ interests must be balanced by policymakers to ensure policies are fair, efficient and effective.

All stakeholders must be involved in policy-making to improve their experience. It would make sure that all stakeholders are heard and policies are equitable and inclusive. Policymakers should also consider long-term consequences of decisions they make on society and the health system. Innovative solutions, such as population health management and value-based care, should be explored by policymakers. These innovative options can increase the quality and decrease costs.

Policymakers are faced with a major challenge in the U.S. healthcare delivery system: the tension between costs and care. A balanced approach to financing healthcare is needed to address the ethical and financial challenges that arise from policy decisions. Policies must include all parties in the decision making process and be equitable and efficient.

References:

Brown, D. (2010 November 8). A Review of Prostate Cancer Drugs Proves Renews Medical Cost-Benefit Debatate. Washington Post. https://www.washingtonpost.com/wp-dyn/content/article/2010/11/07/AR2010110705205.html

Dubois, J. M., & Singh, D. (2017). From Implicit To Explicit: Ethics and Health Care Finance. AMA Journal of Ethics, 19(2), 126–132. doi: 10.1001/journalofethics.2017.19.2.msoc1

Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington MA: Jones and Bartlett Publishers.

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