Read the the case study “Economic Impact of States Declining Medicaid Expansion” page 305 of the Milstead text. 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.

In the U.S., it is crucial that policy decisions are made to decide what type of health care will be covered by private and public insurers. These policy decisions are influenced by the tension between costs and quality of care. The case study by Milstead (2016) titled “Economic Impact of States Declining Medicaid Expansion” shows how policy decisions affect health care financing. According to the author, the Affordable Care Act’s refusal to allow some states to increase Medicaid coverage led to a large number of low-income people being left uninsured. The result was high hospital uncompensated costs.

In the Washington Post article “Review of Prostate Cancer Drugs Provenge Renews Medical Cost-Benefit Debate,” it is apparent that there is a growing concern about the high cost of medical treatments (Brown, 2010). Provenge is a prostate cancer drug that was approved by FDA but Medicare did not cover it. This decision was made because the drug cost too much and the evidence was not sufficient to justify it. The article illustrates policymakers’ evaluations of the cost-benefit ratio of medical treatments, and their ethical implications.

Patients, providers of health care, insurers and policymakers all have competing interests. Insurance companies and government policymakers care more about cost control than they do the quality of health care. Dubois, Singh, (2017) claim that the challenges of ethical decision-making in health care finance include issues such as distributive justice and access to healthcare. The policymakers need to balance these interests and make sure that the policies they create are efficient and equitable.

All stakeholders must be involved in the policy-making process to improve it. Involving all stakeholders in the decision-making process will ensure that everyone’s interests are taken into account and that policies reflect their values. In addition, they must also consider how their decisions will affect the system of health care and the society at large in the future. They should explore new solutions like value-based health care and population management, which can help improve care quality and cut costs.

Conclusion: The tension that exists between the cost of health care and the quality is one major challenge facing policymakers in the U.S. system for delivering healthcare. As outlined in an article published by the Washington Post on the Washington Post website, ethical and financial challenges relating to decisions about policy are a major challenge. A balanced approach is needed to finance health care. The policymakers need to ensure that their policies are efficient, equitable and effective. They also must involve all parties in the decision making process.

References:

Brown, D. (2010). Review of Prostate Cancer Drugs Provenance Reinvigorates Medical Cost/Benefit Debate Washington Post. https://www.washingtonpost.com/wp-dyn/content/article/2010/11/07/AR2010110705205.html

Dubois, J. M., & Singh, D. (2017). From Implicit to explicit: Ethics in health care financing. AMA Journal of Ethics, 19(2), 126–132. doi: 10.1001/journalofethics.2017.19.2.msoc1

Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington: Jones and Bartlett Publishers.