Paternalistic Approach To Health Care

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

There are over 4,500 hospice agencies in the United States but because of funding restrictions and the rigidity of the Medicare Hospice Benefit requiring patients to have a life expectancy of six months or less, millions of Americans do not have access to hospice care. Proponents would state that even with improved access to end of life care, there will still be rare cases of persistent and untreatable suffering. “Oregon, where Physician Assisted Suicide is legal, shows that 88% of patients who opted for Physician Assisted Suicide were on hospice care” (NCBI). Hospice and palliative care are not always sufficient to treat severe suffering. Therefore, even with hospice and palliative care available, some may still choose Physician Assisted Suicide even when on hospice care and others may choose not to use the care

In comparison, healthcare providers are focused on the quality of healthcare in the sense of the accuracy of the health outcome as their primary concern; health insurance companies are more interested in the cost-effectiveness of the healthcare being provided and if the consumer is “paying into the system” (Duke University, 2016).

“The Best Practices: How the New Quality Movement is Transforming Health Care” is written by Charles Kenny, who is an author, consultant, and former journalists at the Boston Globe. The author serves as a consultant to Blue Cross Blue Shield of Massachusetts, where his primary responsibilities are to improve quality and safety. As a consultant, he is familiar with health care news and the situations of the US Healthcare historically. Around 1990, several horrible cases of medical errors in Boston and other cities became a daily news. Medical errors and complications were the fifth leading cause of death, and almost 98,000 deaths were occurring which could be prevented with a quality care. A group of visionary leaders led by physicians Paul

One healthcare trend that needs to be changed is the cost savings vs. quality care that we see more and more with Medicare and other insurance companies. Coverage is denied to people who really need care. After years of attention to cost-cutting in all aspects of healthcare, I believe it is time to focus more on the quality of patient care.

Suffering at the end of life stems from multiple sources, including unyielding pain, depression, loss of personal identity, loss of control and dignity, fear of death, and/or fear of being a burden on others (AAHPM, 2007). The overwhelming symptoms lead many terminally ill patients to ask their doctors to help them die (Gorman, 2015). According to Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York, “their choice shouldn’t be an assisted death or living with intractable suffering” (as cited in Gorman, 2015). The American Academy of Hospice and Palliative Medicine (AAHPM) (2007) strongly recommends that medical practitioners

The Affordable Care Act (ACA) is a federal health reform legislation engineered to provide Americans with high quality, affordable cost and better access to health care [1]. To address these overarching aims, the ACA requires the secretary of the Department of Health and Human Services (HHS) to establish a National Strategy for Quality Improvement in Health Care, also known as the National Quality Strategy (NQS) [2]. The strategy sets three aims. First, to make health care more reliable,

When a terminally ill patient reaches the end of their life, many of them receive hospice care. Hospice can not guarantee how effective they will be in making that patient comfortable or how they will be able to function. The effectiveness varies from extremely effective care to very ineffective care. With such a wide range of effectiveness, patients begin to become concerned about how they will die. Many people find comfort in taking their own life before the drugs do (Sandburn 50). In Oregon, almost one hundred percent of the patients that requested the life-ending medication were receiving hospice care (Goodale, Grossman, and Grundy 16). Hospice was created with its main goal to comfort patients. Recent statistics show the real comfort has been found in the patient's right-to-die by physician assisted

The Institute of Medicine (IOM) Committee to Design a Strategy for Quality Review and Assurance in Medicare defines quality of care to be “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Ransom, Joshi, Nash & Ransom, 2008). Making sure to have current knowledge on healthcare services is crucial to the quality of care provided, and health care professionals are expected to continuously stay updated on the changing trends. The IOM later released six aims for improvement, or also known as the six dimensions of quality, which are safe, effective, efficient, timely, patient-centered, and equitable.

For many people, the process of dying is a prolonged, painful, and emotionally devastating experience. Dying often leaves an individual filled with fear, confusion, and feelings of loneliness and isolation. Fortunately, there are palliative care options that seek to mitigate not only the physical pains and symptoms of death, but also actively work to address the emotional turmoil countless people experience as they begin to descend towards death. On the other hand, far too many Americans still die in intensive-care-units and emergency rooms, where doctors aggressively work to save the lives of all patients, without regarding the actual status or well-being of the person’s life before them. Dying in a hospital room is not peaceful; it is often

First off what is value in healthcare? It is achieving high value for patients must become the overarching goal of health care. This goal is what matters for patients and unites the interests of everyone in the system. The customers do not buy a product. They buy the value and utility that you put into your product. Just like patients and their doctors. The patient’s insurance pays for the doctor’s visit. Instead of being paid by the number of visits and tests they order, providers’ payments are now based on the value of care they deliver.

The first is an attitude referred to as ‘paternalism’. Almost all governments around the world bear the wide spread idea that consumers should not be left to suffer the consequences of poor investment decisions in health. Governments, national and international health bodies through policies proscribe health-risking behaviors such as banning recreational drugs, placing quarantines during outbreaks, and enforcing immunization. In this context, it is assumed that the policy makers know best what is good for the individual e.g. the individual does not know the importance of vaccination and therefore must be protected from their ignorance of poor

Our society finds it difficult to talk about dying and euphemisms are the norm. It is typical for both doctors and patients to be hesitant to initiate a discussion on dying. Focus instead is often more often placed on interventions and actions for managing symptoms. This avoidance can leave patients and their families unprepared for the inevitable death. (Schapira, 2010) It also often results in requests for therapies which may be excessive, costly and even painful in the hopes for a cure. One study demonstrates that when patients are aware that they are terminally ill, the majority are able to reach a state of peacefulness and also exhibit lower levels of distress. (Ray, Block, Friedlander, Zhang, Maciejewski & Prigerson, 2006) It is also important that family members are willing to discuss end-of-life options with their loved ones. According to elderly patients, they are most often the ones who initiate these conversations with their

From my point of view, I believe that the health system is facing a hindrance in providing value to the patient. The inability to provide high quality, low cost health care is now a double edged sword in our industry. In a time where reimbursements are made on the patients perceived quality of their treatment, the organization can no longer afford to run the business off of the volume of patients seen. Moving forward, I believe that there are many changes that can be made, both internally and externally, throughout the health system to successfully implement patient centered care, which would enhance our value chain.