Friday, May 6, 2011

Rationed Healthcare

The cost of healthcare continue to rise, insurance plans and medical facilities sometime propose a rationed healthcare .  It has been debated worldwide about the allocation of scarce resources .  It is said rationing is used when there is a scarcity of resources and its limited availability.   Most Americans believe that everyone is entitled to unlimited healthcare no matter the cost, yet there is still limited resources available. And it is discouraging to most Americans to learn that healthcare can be rationed.  Since the 1950's healthcare professionals  began discuss this problem. Eventually laws and policies were enacted to address the question of "who lives? who dies? and who decides?.  I will be discussing the concepts of rationalize healthcare and the relationship towards nursing. 

As stated from above rationing healthcare is the allocation of limited healthcare resources, which limits an individual from a medical interventions. To understand healthcare rationing it must be understood broadly as it implies the limited resources in healthcare. It involves physical resources such organs, blood products, medical interventions, cost and professional time.  It involves the cost and the ability of patients to pay for hospital treatment. It is rationed whether hospital treatment should be considered such  an MRI for every patient complaining of a headache.  Bedside rationing occurs when nurses engage in decision making for patients with consideration of limited resources and helping them benefit financially with the length of stay in the hospital. Clinicians sometimes  ration the cost of drug such as antibiotics to a less expensive one. Another method of rationing is quality-adjusted life years. This method is used by placing a numerical description on the value that a medical procedure or service can be expected to provide. Thus meaning a measurable life expectancy and quality of the remaining life is assess before variety of intervention is performed. The debate is that how  much of rationing is ethical. Sometimes rationed healthcare becomes dangerous when limited resource is accountable for someone's life.  Another type of rationing is in regards to organs transplantation. When there is a scarcity of limited organs available medical professionals are force to make decisions on who better to benefit from the procedure. These are some of the ethical implications medical professional struggle to pronounce. 

The United States attempted to organize different methods in providing health services and interventions in the state of Oregon's Medicaid program. This program intended to serve the poor citizens of the state of Oregon. Oregon  developed treatment and conditions pairs for the different services provided, meaning treatments are given to patients with a particular conditions. This program has helped the state to be most cost-effective and have helped maximize the health benefits for poorer population of Oregon. 

Although I believe that allocation of healthcare resources is inevitable. Nurses who advocates for patients worry about the care provided for patient. The completeness of healthcare should be thorough for every patient.  A part of  rationed healthcare is amongst the elderly. Some debate about elderly not getting the proper care is ration because of their age. The Alliance for Aging Research provided some of these dimensions. They say that older patients are less likely to be tested or screened for diseases and other health problems.  Proven Medical interventions for older patients are often ignored, leading to inappropriate or incomplete treatment. Older people are consistently excluded from clinical trials, even though they are the largest users of approved drugs. As nurses it is our responsibility to be involved with our patients at every level. We must be aware of every need for our patients including the financial ramifications patient's have to go through and actively meet their needs.  Even though there are limited resources, nurses can be proactive in the allocation of this limited resources. We can be financially aware and be able to educate our patients with uses of these resources. Nancy Falk and Elizabeth Chong asserted that "nurses must be prepared to serve on task forces and committee, as practitioners and leaders, with confidence that their input will help facilitate quality oriented, equitable, decision making."  They said that by being involved in government policy at executive, legislative, and judicial levels nurses can impact tremendously with providing quality care for patients. Falk and Chong also mentioned that nurses must be taught in schools and on the job to be cost effective and make decisions for the allocation of resources.  I believe that since we are the forefront of healthcare. Nurses should be provided with basic education to be fully aware of allocating scarce resources.  Falk and Chong asserted that "Nurses with a voice in macroallocation, and microallocation of scarce resources will help organizations balance the benefits and drawbacks of various decisions and provide  quality care to a greater number of patients in a way the is ethically justifiable.".  

Patient to nurse relationship is not just a clinical practice. We act compassionately and build a strong relationship with our patient because we  do care. We aim to meet their needs at every level because we value their needs. In Leviticus is says "but the stranger that dwelleth with you shall be unto you as one born among you, and thou shalt love him as thyself." Do unto others as what you have others done unto you" is the Golden rule that captivates most Christians nurses to do what they do. As the limited resources and cost of healthcare continue to rise, I believe that nurses should be integrated and value this concern of limited resources. We can educate ourselves in being cost-effective and prioritize needs for our patients. Allocation of healthcare resources is a problem. Nurses can address this problem.