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Running head: ETHICAL CASE ANALYSIS
Ethical Case Analysis
Catherine Quick
Abby Ward
Auburn University/ Auburn University at Montgomery
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ETHICAL CASE ANALYSIS
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Abstract
The Patient Protection Affordable Care Act signed in 2010 by President Obama has
brought the hope of affordable healthcare with radical change to the healthcare system as we
know it. Presently the United States is already experiencing some of these changes effective as of
October 1, 2013. Changes in the healthcare system will be in full effect as of 2014. Some of the
changes include healthcare coverage for over 90% of the population, a decrease in healthcare
deductibles and premiums, and also a limitation on test and treatments. This case study explores
the effects of rationing particularity on the aging baby boomers generation. This case will discuss
both the positive and negative sides of rationing associated with the Patient Protection
Affordable Care Act. This ethical case paper includes leadership perspectives, an economic
analysis and a systems analysis on the macro and micro level.
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Summary and Synthesis of the Case
It is unlikely in today’s time to turn on a television news channel and not hear the term
Patient Protection Affordable Care Act. Pre-existing condition, deductibles and insurance
coverage are quickly becoming a part of our daily vocabulary especially those of the baby
boomers generation. The Patient Protection Affordable Care Act (PPACA) was signed in 2010
by President Obama. The PPACA is a law that allows a change in health insurance and coverage.
This change promises Americans that he or she will have more control over his or her own
healthcare coverage and benefits. The need for healthcare is required at every age. Our bodies
require care from healthcare professionals many different times during our lifetime. The “baby
boomers” are a generation of people who were born between the years of 1946 to 1959. The
baby boomers make up a large percentage of our aging population in the United States. The
healthcare that this generation is starting to require is increasing due to an increase in age.
Therefore, the baby boomer population naturally is greatly impacted by any change in
healthcare. This case study focuses on the baby boomer generation, the impact that the PPACA
will have on them and also the role of the nursing leader during this time of change.
Rationing also known as the “R Word” (Milstead, 2013), is a large part of the Patient
Protection Affordable Care Act. According to the Census Bureau the estimated number of uninsured Americans in 2011 was over 48 million. The Patient Protection Affordable Care Act
promises a decrease in the amount of money the US Government spends on healthcare while also
providing coverage for over 90% of the population. The ethical concern of this case study is not
necessarily if rationing of healthcare is unethical, but rather if the need and reason for rationing
is ethical and moral. Healthcare in the United States is becoming scarce and expensive for the
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individual. Billions of dollars are going to pharmaceuticals companies and unnecessary
procedures. Rationing will help decrease the amount of money the “public purse” has to spend
by limiting treatments and procedures. Annual deaths rise as high as over 20, 000 a year for
those Americans without health insurance with 13, 000 of those deaths each year belonging to
the baby boomer generation (Singer, 2009). Benefits of the Patient Protection Affordable Care
Act directly related to rationing include but are not limited to the fact that insurers will be
prohibited to deny coverage to people based on health status or pre-existing conditions. The baby
boomers, now being aging populations the majority have pre-existing conditions. Therefore, he
or she would still be able to have health insurance. The elders of the baby boomer generation are
now eligible for Medicare. Retirement somewhat goes hand in hand with Medicare therefore
fixed incomes can cause a strain when trying to meet deductibles and pay for prescription drug
plans. The donut hole will be reduced allowing patients to afford medications. New patient care
models will be implemented it is vital for the nurse leader to be aware of the changes in
healthcare and implement the proper form of leadership to provide the patient with the greatest
amount of quality care.
The Patient Protection Affordable Care Act (PPACA) of 2010 has brought the hope of
reasonably priced health care and radical changes to the health care system as we know it. The
number of those without some type of insurance is on the rise. As there is a rise in the number of
participants in the health care system there will be an increased demand for services.
Predominantly in the area of primary care there is currently a shortage of physicians practicing
and entering the primary care field of study out of medical school. In other mature economies,
more than half the physicians practice in primary care, while it is about 30% in Unites States
leaving the remaining 70% as specialist (Goodson, 2010). One of the goals of the PPACA is to
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improve primary care by having additional better-quality providers. Historically, the baby
boomers have been hard workers and providers for their families. What is the reason so many
baby boomers are faced with difficult choices such as to seek health care and buy medications or
pay for necessities like: food, utilities, and a mortgage? As these retirees adjust to not only to a
fix income, they are faced with growing health problems that just come with age. Now as they
reach retiring, we find many of these hard workers have neglected themselves in basic care such
as: routine check-ups to monitor for high blood pressure, diabetes, and high cholesterol. As they
age, seniors often have greater and more costly health care needs so having affordable health
care is crucial (Park, 2012).
One way for the government to cut costs is through rationing. According to (Reinhardt,
1996), rationing is the delivery of scarce goods or services to the majority. With government
controlled health care such as in Canada and England, the allocation of resources can lead to
waiting lists and long lines for treatment (Coleman, 2011). Coleman states that Senator Daschle
approves of Britain’s National Institute for Health and Clinical Excellence (NICE) use of
resources to determine which patients’ are eligible to receive which medications and services,
and the United States should follow suite (2011). Many factors are used in the rationing of
health care. By limiting the number of resources available in an area like CAT scans and MRI‘s,
a common practice in Canada and England, costs can be controlled. First you go to the general
practitioner; next you are referred to a specialist who recommends surgery all the while at each
stage you wait to get an approval before you can move on. People literally die waiting for
treatment because of rationing. The practice of rationing should not be used exclusively based
on a person’s chronological age or their quality-adjusted life year (QALY) which is cost
efficiency measurement used to determine the cost of treatment per year for different conditions
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to approve or deny them access to necessary medical treatment and place them on long wait lists
that could contribute to death (Milstead, 2013). The practice of treating people like numbers and
not like human beings is the wrong reason to be in the health care industry. The PPACA should
be able to provide access to medical care without placing undue hardship on the consumers.
Leadership Perspectives
There are several leadership styles this paper will focus on. They are quantum leadership,
transformational leadership, shared leadership and transactional leadership. In quantum
leadership, nurses are motivated to act in the hospital’s best interest. Quantum leadership is the
form of leadership that is the most beneficial for the nurse to portray when working with the
aging baby boomer population and the effects of rationing. Quantum leadership is being able to
adapt and mold to the constant changes we are faced with in healthcare today and adequately
develop relationships with the patient that is necessary for proper holistic care. With the Patient
Protection Affordable Care Act nurses must portray the characteristics of quantum leadership.
Quantum leadership is determining the value of healthcare. The Patient Protection Affordable
Care Act supports the fact that valued care is based on cost, quality, and service. As a quantum
leader dealing with healthcare rationing and the increasing aging of the baby boomer generation
the nurse leader must ask the questions such as what is the service being provided and what
impact do these services have on the patient and also the community (Porter-O’Grady &
Malloch, 2011). Quantum leadership will allow the nurse to make decisions that are based on
quality care and also cost effective for the patient this is a form of rationing that is beneficial to
the patient. The quantum leader is able to adapt to the changes in healthcare and offer the best
quality of care to the patient also by maintaining cost. The theory is when properly inspired not
only does the individual succeed; the company does as well (Porter-O’Grady & Malloch, 2011).
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More emphasis is placed on building relationships and establishing trust among the team
members. This type of leadership could have a powerful effect on health care through the Patient
Protection Affordable Care Act (PPACA). This type of leadership focuses on risks and benefits
of a given situation to decide what’s best for those involved.
In transformational leadership, individuals focus on employee development by
encouraging further education, individualized training and mentoring (Porter-O’Grady &
Malloch, 2011). The mentor takes the time to challenge their mentee to become leaders
themselves. Because employees are free to express themselves in a creative way, rapid growth
and develop occur. The recommendations for this type of leadership with the PPACA could be
very encouraging. Doctors, administrators and policy makers can join forces to write legislature
to help everyone affected by PPACA.
Shared leadership requires the nurse to be an active listener. During times of change
being able to listen to others concerns, needs and wants is vital when serving as a leader in order
to implement change. Healthcare is a shared system therefore; this type of leadership can be
effective when collaborating with other healthcare professionals. We as nurses must learn to
become shared leaders in order to provide the best quality of care. Shared leadership is shared
among all employees, depending on their strengths and weakness. This style of leadership is
based on doing what is morally right if it produces happiness for the majority. One advantage is
that no one person is more important. Propositions for this leadership style and policy making
with PPACA would be encouraging. The decisions would be a common idea to promote a
solitary goal.
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Transactional Leadership is a type of leadership that is seen as a more concrete form of
leadership. Transactional leadership can be used when a specific task has a deadline and must be
completed. During this time of healthcare change nursing leaders need to know when to be
abstract and when a more concrete form of leadership is required. With change come confusion,
questions, and sometimes the increasing chance for miscommunication we as nurses must know
when each type of leadership styles is appropriate to enforce.
Economic Analysis
Free health care for everyone is theory. But at what cost to the rest of society? Currently
the federal government is set to start running the health insurance exchange in the state of
Alabama in 2014. Are there any ethical implications to consider ensuring everyone has
healthcare? In order for the government to provide free health care to everyone; the money has
to come from somewhere. The easiest and most logical way for the government to raise revenue
is by increasing taxes.
Another way for the government economic implication would be to decrease provider
reimbursement. By raising the standards too high, providers are unable to comply with
unrealistic goals for reimbursement for routine procedures, labs, and core measure compliance.
Some small independent clinics close due to lack of funds. In states like Alabama and
Mississippi that have lots of rural areas this could mean losing the only physician in tri-county
area. As future nurse practitioners that must practice under a physician’s supervision it is very
disheartening to think that rural communities could be abandoned with this change in health care.
However, as mentioned above the baby boomer generation is aging. The need for
Medicare is increasing. The Patient Protection Affordable Care will provide reductions in
Medicare fees that will save over 190 billion dollars over the next decade. This save in revenue
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will allow the quality of care the aging baby boomers receive to be better and also cost friendly.
Over 18 million adults aged 50 to 64 are expected to see an improvement in their health
insurance protections as provisions of the Patient Protection and Affordable Care Act in 2014,
according to a new report from the Commonwealth Fund (Anderson, 2010). Uninsured baby
boomers are in serious need of healthcare and a large percentage of them have admitted to not
receiving the proper care due to cost while over 70% of the baby boomer generation are in
medical debt. A benefit of the Patient Protection Affordable Care Act is that everyone will have
access to affordable health care.
Macro and Microsystems
When comparing the Patient Protection Affordable Care Act to a macro system, one
should think of it on a global perspective. The PPACA can be compared to other countries, like
England. England is a country with government controlled socialized medicine. The down side
to this is similar to the health maintenance organizations (HMO) plans in the United States, not
being able to pick your own doctor and long wait times for referrals and surgeries. Though this
system has it is imperfections, everyone does has access to health care.
At the micro system level would be the state. Health care providers in Alabama need to
be educated on the PPACA in order to better equip patients and their families. Clinicians must
be well versed in the different treatment, testing and medication options available through these
programs for their clients.
Nurse practitioners need to be fully involved in their state organizations like Alabama
Nurses Association. Nurse should actively participate in their local community. By attending
regularly meetings on local and state level, not only do you advocate for your patient needs but
you also can lend support for health care issues important in own your practice.
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Conclusion
This paper has presented an ethical case analysis with regard to the Patient Protection
Affordable Care Act (PPACA) and how the rapidly aging baby boomers generation would
increase a demand for services without an increase in providers. The paper discussed the ethical
dilemmas presented on both sides of the PPACA. Leadership perspectives were described with
the implications and how they relate to the PPACA. The economic analysis, micro and macro
systems were also discussed is this paper. Clinicians need to be familiar with the PPACA so
they can provide high-quality, effective and safe care to patients. Nurses must exemplify
leadership at all times; the quality of care the patient receives must still remain the top priority.
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References
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