Description
PART 1;
Social Justice in Health Care Distribution
The purpose of this assignment is to give you an idea of how challenging it is when health care is a scarce resource. There will never be enough money for everyone to have every health care service they may need or want. Who makes these decisions? Perhaps a government agency, perhaps an insurance company. It is easy to blame a nameless, faceless business for denying care. But what if it was you? What if you worked in that field and the burden to allocate too few resources to too many needy patients sat on your shoulders? Might you have a completely different perspective? How do payors determine what to cover? The answer is simple and complex at the same time. Payers generally do not cover anything experimental. They have clear policies for what specific plans cover. They often require preauthorization to ensure that the test/procedure is truly necessary and that it is supported by best practice showing improved quality outcomes.
In this case you are not working for an insurance company. You are a senior executive in a hospital. The hospital sets aside charity care monies each year to assist needy patients. There are always more needy patients than there are funds. When the funds are gone, they are gone. This year, you are tasked with distribution of the money.
None of the patients have insurance or any significant funds. You have 1 million dollars. It cannot be used for more than one patient.
The patients are as follows:
1.Patient A is a 70 y/o retired business executive who needs a $500,000 heart transplant and $500,000 in post care surgery (i.e. medications, rehab, follow- ups, etc.)
2.Patient B is a toddler with cerebral palsy (affect a person’s ability to move and maintain balance and posture) who needs $500,000 for ongoing care. With expert care the expected lifespan is teenage.
3.Patient C is a 32 year old mother of 2 who needs a $750,000 bone marrow transplant and $500,000 in post care surgery (i.e. medications, rehab, follow- ups, etc.).
4.Patient D is a 38 y/o athlete who needs a hepatitis C drug that costs $30,000/ month. The patient could live a normal life span as long as the drug is provided.
5.Patient E is a micro-premature baby who is costing $10,000 day with a 20% chance of survival. The hospital stay is expected to be 12 months minimum, not including any needed surgical procedures, and not including likely life-long health care needs if he survives.
Determine the distribution of health care funds
Include the following aspects in the assignment:
ØWhich patient should receive the funding and why?
ØIf the funds were available to be shared among the patients, would you have chosen differently?
ØHow did you feel having to make a choice?
ØDiscuss if this exercise has changed your view of the challenges behind paying for health care.
PART 2:
Urgent Care and Primary Care
You receive a fax from a local urgent care clinic describing the recent visit of a patient that has come to the primary clinic where you work. You notice this patient has been seeking care at the urgent care clinic and has not been seen by the primary care health care providers for more than a year. The manager asks you to educate patients about urgent care clinics and traditional primary care clinics.
Distinguish between two health care models.
Include the following aspects in the assignment:
ØCompare urgent care and primary care
ØDescribe the advantages and disadvantages of each
ØIs there a difference in quality of care provided
ØHow many of each type of facilities (urgent care and primary care offices) exist in the U.S.
Explanation & Answer
Attached.
Running head: SOCIAL JUSTICE IN HEALTH CARE DISTRIBUTION
Social Justice in Health Care Distribution
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SOCIAL JUSTICE IN HEALTH CARE DISTRIBUTION
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Social Justice in Health Care Distribution
In the determination of the distribution of health care funds each patient is equally
important. However, from the five case studies, Patient C who is a 32 year old mother of two who
needs a $750,000 bone marrow transplant and $500,000 in post care surgery should receive the
funding. Despite having a need of more than 1 million dollars, her chances of surviving up to the
expected life expectancy is high.
In event that the funds were available to be shared among the patients, I will still give the
patient C the first priority. I will also consider patient D sinc...
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