My course is Ethics of Healthcare – Master of Health Administration.

a. Directly posting their own responses as answers to the questions below. Write in no more than 600 words but no less than 500 words.

1. How has the Affordable Care Act (ACA) of 2010 changed the U.S. health care system? What ethics challenges will be present in the ACA era?
2. What are or would be the most common ethics issues in managed care you may find?
3. Technology has certainly changed the way medical care is practiced. Brainstorm all of the technological changes you have seen in the last five years. Include both information and clinical technologies. Now consider what ethical issues these changes have created. Technology brings great benefits but also produces new ethical dilemmas for health care.

b. Reply to at least one classmate in no more than 200 words but no less than 150 words.

Reply to my classmate Discussion:

1. The ACA of 2010 changed the US health care system in that it allowed for many previously uninsured Americans to have access to health insurance and therefore healthcare. It also allowed children and young adults to remain under their parent’s health insurance policy until the age of 26. Lastly it created a “penalty” for those people who do not qualify for taxpayer-funded health insurance, but who do not have the resources to pay for their own subsidized health insurance policies. These changes caused a few ethical challenges including, but not limited to, the all-too-common challenge of resource allocation and distributive justice. Healthcare (drugs, procedures, doctors, nurses, other staff, etc) are a limited resource and with the influx of patients who are entering the health care system with an insurance plan there are bound to be some resource allocation dilemmas. There is also an ethical dilemma by way of infringing on civil rights to force people to buy health insurance who choose not to. By instituting a penalty to those people who are unable to afford health insurance, the government is taking away their right to choose whether or not they want to purchase it. This was especially problematic for young healthy Americans who encountered high premiums for health insurance plans that they were forced to purchase. Some felt that they were paying high premiums to subsidize the cost of caring for the elderly and sick population, and they were not completely wrong about that.
2. I anticipate the most common ethics issues I will face in managed care will be surrounding the allocation of resources in an aging population. I also anticipate being challenged with ethical issues surrounding end of life care as hospice is being utilized as a safe and appropriate alternative discharge plan. Although I agree with hospice and palliative care in lieu of expensive medical tests and treatments when those treatments are largely futile, there will be certain ethical challenges with convincing patients and their families that you are not “giving up” on them.
3. The largest technological change I have seen in the last 5 years was converting to paperless electronic medical records, and then being granted access to those medical records on private laptops and even iphones at home. I frequently place orders and manage patients from my home after I have left the hospital. This convenience highlights the advancements in technology that I am privy to however also presents ethical dilemmas especially in regards to autonomy and a patient’s ownership of their healthcare records and their right to privacy. I have also seen advancements in technology surrounding procedures performed in the hospital. What used to be a 3 night hospital stay is now performed in same-day surgery and discharged from the post- anesthesia recovery unit. This advancement in technology is both good and bad for patient care. For example, if patients are poorly triaged prior to surgery, then a procedure might be performed on a high risk patient in an ambulatory setting which might lead to poorer patient outcomes. The last advancement in technology I have seen is the use of telemedicine. There was a recent news article about a patient being told “by a computer” that he is dying and has hours to live. Although this is not an accurate reflection of what happened, it certainly gives us an idea about how patients and their families view the advent of telemedicine and the potential downsides of it’s use in critically ill patients.

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