Prostate Cancer Drugs Provenge Financing Of Healt

Financing of Health Care

With coinciding concerns about health care costs and the imperative
to improve quality of care, health care providers and others face
difficult decisions in the effort to achieve an appropriate balance.
Such decisions often are addressed in the policy arena. How do
policymakers evaluate which health care services should be financed
through government programs? How do ethics-related questions and other
considerations play into this evaluation process? Is it possible to
contain costs and provide accessible, high-quality care to all, or is
the tension between cost and care inherent in the U.S. health care
delivery system? These questions are central to health care financing
decisions in the United States.

For this Discussion, you will focus on the policy decision-making
process that determines what types of care are covered by public and
private insurers and the ethical aspects of such financial decisions.

To prepare:

• Read the following case study, “Hard Economic and Finance Choices in US Healthcare” (Milstead):
  • Case Study 1: Hard Economic and Finance Choices in US Healthcare
    Applied
    economics is all about managing scarce resources. Economics is an
    amoral field of study: it is neither moral nor immoral. Morality and
    values are determined by individuals at the personal level and by group
    consensus or majority opinion at the national level. State and federal
    governments determine the ‘will of the people’ about how to use scarce
    resources for the good of a nation.

    The U.S. health care
    system is an exemplar of scarcity: primary care physicians, substance
    abuse treatment centers, trauma centers, registered nurses, and the
    money to pay for goods and services. Finance is all about how to pay for
    goods and services. The Medicare Payment Advisory Commission (MedPAC)
    is appointed by the Executive branch of the federal government to make
    decisions about what the Medicare program will and will not pay for. In
    this role, MedPAC makes decisions about medications, procedures and
    treatments. Examples of MedPAC decisions include coverage for left
    ventricular assistive devices as a destination therapy, coverage for
    bariatric surgery, and in 2010, coverage of the drug Provenge™. By law,
    MedPAC is not allowed to use price or cost of any treatment in its
    decision-making processes.

• Review the information in the Washington Post article “Review of
  Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate” in
  the Learning Resources.
• Consider how policy decisions currently are made about what will
  and will not be paid for and what changes, if any, could improve the
  process.
• Reflect on how the Washington Post example illustrates the tension between cost and care. References:
  National Health Expenditures 2010 Highlights, Centers for Medicare & Medicaid Services (n.d.). Retrieved from https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf.
  Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.
  Write your analysis and assessment of the ethical and economic challenges related
  to policy decisions such as those presented in the Washington Post
  article. How does this type of situation contribute to the tension between cost
  and care? Substantiate your response with at least two outside resources. Use the following headings to answer the question:
  Healthcare Financing
  Analysis
  and Assessment of Ethical and Economic Challenges Presented in Washington Post
  How
  This Situations Affects Cost and Care