Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Chapter 14 Consumerism and Ethics

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Objectives After completing this chapter, you will be able to: –Identify key concepts of consumerism and how they impact health care –Define consumer driven health care and its impact on the health care environment –Identify different types of health care reimbursement that are a result of the consumer-driven health market

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Objectives (cont’d.) –Understand the interrelationship between retail medicine, consumer’s choice and health marketing –Understand the role of social networking in consumer-driven health care –Comprehend the influence of Microsoft and Google’s investment in PHRs on the health care environment –Differentiate different ethical principles and how they are demonstrated in health care

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Purpose Provide information and resources concerning role of consumerism and ethics in health care environment: –Exploration of consumerism, key concepts and challenges –Examine how health care reimbursement market has changed –Understand ethical considerations in health care

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Consumerism: Key Concepts and Challenges Health care traditionally considered provider or medical-driven environment Recent trends include consumer-oriented or consumer-driven health care system: –Change in demographics/socioeconomics, shortage of health care professionals, shift toward chronic care, and increased consumer expectations provided impetus for alternative forms of health care

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Consumers, Consumerism and Economics Consumer: person who uses up a commodity; a purchaser of goods or services, a customer Consumerism: doctrine advocating continual increase in consumption of goods as a basis for sound economy Consumer-driven health care: health care directly motivated and impacted by what consumers expect and demand

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Key Principles of Health Care Consumerism Consumerism in health care strategy encourages and enables people to take charge of personal health through: –Knowledge of current status and needs –Informed decision-making –Wise use of health care dollars –Confident and active participant in own health care decisions and treatment choices

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Key Principles of Health Care Consumerism (cont’d.) Basic principles needed for consumer- driven market structure that can be applied to health care: –Access –Choice –Information –Redress –Representation

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Key Principles of Health Care Consumerism (cont’d.) “Mega-trends” that impact demand-control model of health care: –Personal responsibility –Self-help, self-care –Individual ownership –Portability –Transparency (right to know) –Consumerism (empowerment)

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Shared Decision-Making and Transparency Consumer awareness of service/product quality and cost are key drivers of transparency in health care Do health care consumers have information to effectively make decisions? –Health care environment needs to become more transparent in its approach to information utilization and access

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Health Information Privacy Consumers versus providers: users of published information: –“What information should be made available” and “to whom?” HIPAA and the “need to know”: –Specifies regulations for privacy of personal health information, portability of health insurance, and organization of interchange of electronic data

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Health Care Reimbursement and Consumerism 1930’s: Blue Cross and Blue Shield began offering private health insurance 1960’s: Medicare and Medicaid were signed into law offering public insurance 1970s and 1980s: managed care organizations lead design in health plans 1997: The Children’s Health Insurance Program (CHIP) emerged

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Consumer-Driven Health Plans (CDHPs) Designed to allow employee greater choice in health care thus enabling them to be wise consumers CDHPs provide: –Information to aid in selection of providers etc. –Greater choices in services –Allows employee to design own health plan including benefits covered, deductible, co- pay, and providers

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. High Deductible Health Plans (HDHPs) Broad provider network Limited involvement with medical management Higher deductibles Lower premiums Also referred to as “catastrophic” health insurance

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Reimbursement Accounts for Non- Covered Health Expenses: HSAs, MSAs, FSAs and HRAs Optional savings accounts established for depositing pre-tax monies to use on specified health-related expenses: –Flexible Spending Arrangements (FSAs) –Health Savings Accounts (HSAs) –Medical Savings Accounts (MSAs) –Health Reimbursement Arrangements (HRAs)

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved.

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. The Role of Consumers In Health Management Personal health management: key concepts and responsibility –Today public is more aware of health concerns and personal responsibility –Key areas for improvement for American population include: obesity, increased exercise, nutrition, health screenings for disease such as heart disease, diabetes, high blood pressure, cancer and genetic diseases

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved.

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. The Role of Consumers In Health Management (cont’d.) Wellness and the consumer: –Health information technology has changed way medicine and health care are delivered Social network sites and health management: –Social networks contribute to increased public awareness of health and wellness issues and used as media to disseminate information to larger numbers of people

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Electronic Health Care Records Electronic Medical/Health Records (EMR/HER) versus Personal Health Records (PHRs): –Health or medical information that is stored, utilized, retrieved, or shared electronically Personal Health Records (PHR): –Electronic repositories for personal health information, whereas electronic health records reside in health care organization’s database

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Retail Medicine Key concepts: –Health care services provided in “retail settings” or non-hospital, non-traditional medical environments –Minor emergency health care clinics, convenient care clinics, lasik centers, dental clinics and cosmetic services –Emphasis on customer as consumer of services has changed health care environment toward more market-based

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Choices and Challenges in Retail Medicine Convenient Care Clinics (CCCs) Complementary, integrative, and alternative medicine considerations Concierge medicine and global competition

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Ethical Considerations In Health Care Consumerism may cause controversies between ethical decision-making and treatment options –Does everyone have the right to all treatment options? –Should the truth always be told even if it jeopardizes the patient’s health or well-being?

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Ethical Considerations In Health Care (cont’d.) Autonomy Privacy Confidentiality Fidelity Veracity Nonmaleficence Beneficence

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved.

Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Ethical Considerations In Health Care (cont’d.) Justice Clinical bioethics: rights and responsibilities Research considerations and human subject protection Patient rights Ethics and the health care manager