Healthcare Policy Hospital Policy Issues

Healthcare Policy

Hospital policy issues related to access to care:

Administrator. From the administrator's point-of-view, access to care represents an ethical dilemma. Ideally, all patients would have equal access to care, but the hospital cannot afford to finance care for all. Thus, there needs to be a balance between providing care for those who have insurance coverage, and finding ways to provide the means for those without coverage to pay as well. The administrator therefore must balance the standard of care, the availability of care and the finances of the institution.

Patient. The patient is oriented towards receiving the care that he/she needs. Cost of care is not relevant to the patient, who only wants to get better. This becomes an issue when the patient cannot afford the care he/she needs.

Physician. The physician is guided by the Hippocratic Oath to provide the medical assistance that all patients need. The ability to deliver the highest standard of care is the greatest concern. The physician therefore is oriented towards the highest availability of care.

The politician is oriented towards his/her constituency's needs. In the United States, this varies by party platform. Some politicians therefore are oriented towards the provision of health care, while others are oriented towards the budget aspects of the health care industry. At present, the politician's views of Medicare, Medicaid and the Affordable Care Act can vary strongly by political affiliation but there are few politicians without a plan or an opinion on the availability of health care.

Tax payers must balance the desire for health coverage with the cost of that coverage. As with politicians, views on this issue vary dramatically, ranging from a view to minimize taxes to a view to maximizing care availability in the society.

Board members are oriented towards the mission of the institution. In some cases, the mission is to maximize profit. This can be done by optimizing other outcomes, such as patient outcomes, quality of care or other aspects that can give the business a competitive advantage. Board members are a diverse group, however, and some may not put the financial perspective first, and instead would choose to broaden care.

Staff members are oriented towards a high level of health care, and that also means maximizing the availability of health care.

The cost of care within the system:

The hospital administrator wants to balance the cost of care provision with the revenues generated by that care. The administrator also wants to ensure a high quality of care, but again cost is important.

For the patient, cost is not necessarily important, unless it becomes a barrier to care. Patients whose care is not prescribed by an insurance plan may prefer to receive a number of different options at different price points. Depending on the patient and the ailment, cost could be no issue, or cost could be a major deciding factor in the patient's views on care.

The physician is not typically oriented towards cost, as this is subordinated to medical decisions.

The politician is at least oriented towards cost where it concerns publicly-funded programs. The choice is often to control costs, though some politicians are less concerned about this. Even with health care that lies outside of government control, cost can be an issue when it affects voter decision-making. Usually, however, politicians are much less concerned about the costs of private enterprise transactions.

Tax payers are always looking for value, especially in public services. Even when tax payers want health care -- and they usually do for seniors -- they still consider cost control to be an important aspect of that care.

Board members are oriented towards controlling the cost of health care, because when costs are controlled, profits are increased.

Staff members usually have little cost orientation, because they are not involved in the financial aspects of their jobs.

Quality of care within an organized hospital system:

Administrators usually are concerned about the quality of care, in balance with cost. Most organized systems like to offer a high standard of care, as this is a key point of competitive advantage.

Most patients want the highest quality of care possible, because it relates to their health and the quality of life that they will live. Only when cost makes the care prohibitive are patients going to be willing to sacrifice quality.

Physicians typically have no interest in sacrificing the quality of care that they give. They prefer to work without constraints on quality. Given the choice, physicians would maximize quality of care and not worry about the other aspects, aligning their interests closely with those of patients. Physicians are concerned about malpractice risk, so prefer to eliminate that.

For all their differences, politicians almost universally seem less concerned about the quality level of the care. They are not in the medical profession usually, so have little knowledge of quality issues, and ultimately the standard of care is not as important a voting issue as the cost of it, or its availability.

Tax payers are likewise not as interested in the quality of care. When the program provides care for free, the tax payer is not as fussy about the care. Tax payers generally prefer there to be a balance with respect to quality and cost, such that paying for the highest-levels of service can only be done when it does not unduly affect their tax bill.