Recent Public Sector Influences
Hello and welcome to the discussion about public sector’s influence on healthcare policy. Last week, we discussed the Affordable Care Act (ACA) 2010. The ACA was responsible for expanding healthcare coverage for millions of Americans; and accomplished the following
- Lowered healthcare costs
- Ended pre-existing exclusions for children
- Kept young adults (under the age of 26) insured under their parent’s healthcare plan
- Provided preventive care at no cost, and allows people to seek emergency services outside their plan (US Department of Health and Human Services, 2015).
The goal behind the ACA is to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors.
Public Sector Influences on Death With Dignity
Since no aid in dying law exists in Arizona, let’s look at how the public sector influences the Death With Dignity law and efforts to protect the uninsured, underinsured, disabled, and those with any other health disparities.
A great place to start was a guidebook for medical professionals written by an Oregon task force to improve the care for terminally-ill patients. In the guidebook it covered many areas including patient’s rights and responsibilities, mental health consultations, and financial issues.
Here are some statements I found important for this topic:
- Patients have the right to their medical condition and prognosis to order to make informed decisions regarding treatment options
- Patients have the right to know if their healthcare provider, healthcare plan, or system participates in the Death With Dignity Act
- If a patient should change physicians in order to obtain a prescription from a participating physician, human and skilled care must continue until the transfer is complete.
- Patients only deemed mentally-competent can participate in the law.
- A Depression screening is recommended for all patients wanting a lethal prescription. If the screening is positive, a referral to a psychiatrist or psychologist is warranted.
- If perceived patients are choosing lethal prescriptions due to financial burdens should be explored
- Physicians, hospitals, or others involved in care who are perceived to have a direct or indirect financial interest should be disclosed during discussions about treatment options (Oregon Health and Science University, 2008).
I found the financial points interesting. It never states who exactly pays for lethal prescriptions, but through some more investigation I discovered that the Death With Dignity Act does not specify who pays for the services, but it is decided upon individual insurers (and under the Act it is not deemed suicide so insurers cannot view as such upon determination). Also, no federal funding can be utilized for services, so if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014).
Recent articles report how President Obama would like Medicare to reimburse providers for end-of-life counseling. Obama wanted to include this in the ACA, but opposition quickly followed. Remember Sarah Palin’s death panel discussions? Since 2010, Medicare did mandate coverage for advance care planning during wellness visits; and private insurance companies, like Blue Cross/Blue Shield of Michigan, are reimbursing $35 for end-of-life discussions (Compassion & Choices of Washington, 2014).
Since aid in dying state’s decision, it will be up to the state government to influence healthcare policy; and protect the under served in it’s decision making process.
Below is a video about the ACA…do you agree with these stances? Are seniors and those with disabilities be targeted for these ‘death panels?’
See you in Week Seven!
Compassion & Choices of Washington (2014). Coverage for end-of-life talks. Retrieved from http://compassionwa.org/news/coverage-end-life-talks-gaining-ground/
Oregon Health and Science University (2008). The Oregon Death with Dignity Act: A guidebook for healthcare professionals. Retrieved from http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf
Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf
The Big Picture (2014, May 22). Sarah Palin was right: There are death panels in America. Retrieved from https://www.youtube.com/watch?v=6mD7iYFovdk
United States Department of Health and Human Services (2015). About the law. Retrieved from http://www.hhs.gov/healthcare/rights/