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Topic: Cost
June 10, 2014 | Posted By Jane Jankowski, DPS

No one seems to know what the answer is to keeping costs down in healthcare but grand efforts have been undertaken to find someone to blame. Some of the targets are patients, others are providers, and sometimes the insurers are dragged into the fray as well. The rhetoric is tired and worn on both ends.  Is it the folks with chronic diseases like diabetes? Is it the folks who need dialysis? The smokers? The patients who do not follow the doctors’ advice and stay sick and expensive? The people who want ‘everything done’ at the end of life? Is it the doctors who acquiesce to patient demands or the laws that obligate them to do so? Do doctors order too many expensive tests, bleeding insurance system? Is it the liability insurance that must cover them if they fail to order a test? Maybe it is the insurance companies paying high salaries to executives while handing down ever-shrinking reimbursements pressing institutions to find new ways to eek out enough income to sustain an operating budget. Newer to this menu are penalties for staying in the hospital too long and coming back too soon. This latest addition to the list is perhaps among the most absurd.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

April 29, 2014 | Posted By Marleen Eijkholt, PhD

Earlier this month, the New York Times (NYT) reported on individuals in a minimally conscious state (MCS). Although the article headed: ‘PET Scans offer clues on Vegetative States’, its contents addressed the technologies around MCS: a ‘newly’ diagnosed state of consciousness. The paper commented that PET scans would be more beneficial than functional Magnetic Resonance Imaging (functional M.R.I.) in diagnosing this state. Around the same time, the NYT published a paper that headed: ‘Cost of treatment may influence doctors’. This paper quoted a doc saying: “There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,”

In this blog post I want to focus on the cost and price of consciousness. I do not only want to focus on the economic costs, but also on costs in a more holistic sense, including the psychological and emotional costs. In the end, I want to ask you: how much is consciousness worth to you?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.bvg

April 14, 2014 | Posted By Jane Jankowski, LMSW, MS

A coach is defined as a person who is tasked with teaching or training others, usually in conjunction with athletic endeavors. When this term is applied to health, we often presume the coach is a personal trainer of sorts, focusing on optimizing fitness and nutrition for those who can afford the fee for this level of personal attention. Over the last few years, however, there has been a growing movement to provide a different kind of health coaching within the medical arena for patients who have difficulty adhering to health related regimens for medication, office visits, and management of chronic medical problems. This endeavor has been found to work for many reasons, but remains in the wings of the contemporary healthcare industry.

The first time I read about the concept of community based health coaching was via Atul Gwande’s article “The Hot Spotters” published in 2011 in The New Yorker magazine included here in its entirety for interested readers. What resonated for me was the comment from one recipient who stated that the coach was effective because of the way the advice and encouragement and nudging was delivered, “Because she talks like my mother” implying that there is understanding, concern, and discipline delivered as the underlying message between coach and patient. I think most good athletic coaching is the same. While success is not measured in trophies, medals, or college scholarships when it comes to medical coaching, the potential for life changing outcomes are very real. And the opportunities for cost savings are very real as well.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 25, 2013 | Posted By Wayne Shelton, PhD

The political right in the U.S. has mounted a formidable effort from the outset to mischaracterize the aims of the Affordable Care Act (ACA) and to mislead voters about the need for fundamental reform in healthcare. I take it as a given that the opposition to the ACA has never been about its efficacy to promote certain goals to expand coverage for more Americans; even if the ACA accomplished its goals perfectly, those on the extreme political right would still oppose it. That is, the opposition from the political right is not about whether or not the ACA will work effectively but about ideology—they oppose the ACA as a matter of principle. They are committed to the view that government should not be involved in healthcare and fear, perhaps rightly, that if the ACA proves workable it would lead to a single payer system of universal coverage for all citizens. They apparently see healthcare services being like any other market service provided in a capitalistic society. But upon even a superficial analysis, this position is flawed.

It is basic to free markets that the ability of an individual to use a certain service or product is a function his or her ability to purchase it. One of the few services that is an exception in our current capitalistic society is healthcare, albeit only at the level of requiring services at an acute level. For example no matter how desperately I need transportation to go back and forth to work, I will not get a free car as a function of someone else’s obligation to provide it. This is not true of healthcare: even if I cannot pay for healthcare or I lack healthcare insurance, if I get sick enough and show up at an Emergency Room, I’ll not only be stabilized, I’ll be hospitalized and be given all I need to improve, or more fittingly, to be rescued from dying.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

October 28, 2013 | Posted By Jane Jankowski, LMSW, MS

With contentious changes afoot in the US healthcare system these days, one old problem seems to be gaining important attention as the public reflects on what will change with the advent of the Affordable Care Act. The cost of prescription medications is often so high; patients are forced to make tough choices in order to maintain their health without going broke. This topic was front page news in the New York Times (New York Times October 2013 ) this month where the focus was on escalating costs of asthma drugs. Compared to other nations, the expense of many common – and even not so common – medications is dramatically higher for consumers in the US. This is hardly news, and studies have been done showing that senior citizens were historically the hardest hit by medication costs given the intersection of age related health problems and fixed incomes with no prescription benefits. Though somewhat ameliorated when Medicare D was added, not all of the medication problems are resolved, particularly when an individual requires skilled nursing care in a nursing home (Medicare D and Nursing Home Residents.)

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 24, 2013 | Posted By Jane Jankowski, LMSW, MS

At a Labor Day party earlier this month, I was among the lucky guests filling a plate with an array of tasty picnic food ranging from the traditional cook out items to exotic salads and fruits, all washed down with a blueberry martini. (NO, I do not have the recipe.) Food represents many things in our culture and expresses values in subtle ways – and not so subtle ways. Bidding farewell to summer and enjoying the blessings of some great local produce, I noted that the centerpiece of my meal was a thick grilled hamburger.  Unless otherwise stated, it is presumed to be made of beef. And I had to wonder: will burgers like this one become scarce in my lifetime? With the recent production of meat grown from bovine stem cells, there is speculation that lab-grown meat product will someday replace animal meat as a primary food source. It seems important to consider what is, um, at stake for consumers, for science, and the evolving culture of lab grown food.

As for this new use of stem cell technology, I think we need to question whether or not this was the best use of resources. At  an estimated cost of over $300k, it was terribly expensive to create, but many new technologies come at a price. This Petri dish patty was reported to not taste very good, a shortcoming blamed on the absence of fat in this manufactured patty. However, it was deemed safe to eat and as far as I know, none of the taste testers became ill from ingesting the “schmeat.” Engineered beef might find a welcome in areas where there is mistrust about food safety and where food supply for meat products is limited. Yet, refrigeration needs may still prove a formidable barrier even if cost of manufacture and shipping could be assured. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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