Dimensions (Criteria) and Define Them in No

¶ … dimensions (criteria) and define them in no more than one paragraph each.

Safe: avoiding injuries to patients from the care that is intended to help them.

Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.

Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.

Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status

(quoted from: Committee on Quality of Health Care in America, IOM)

Part B. Question 2b (2. In no more than one paragraph each, please evaluate the importance of each attribute from the perspective of: a. The clinician, b. The patient, c. The payer (insurance company or cms), d. society.:

The clinician will rate technical performance as most important, because that's how they're trained: to be the best in their class. Responsiveness to patient preferences comes a distant second, because they are bound to obey patient directives. The hospital will encourage them to be efficient with their time, and the need to build a practice will lead to the management of interpersonal relationships. Amenities of care will follow, as patients will not go to unpleasant or unsafe doctor's offices. Cost effectiveness is least important, because they're not paid to be cost effective.

The patient will naturally rank responsiveness to their preferences as most important, followed by the management of interpersonal relationships, because interpersonal relationships are somewhat determinative of the response to their preferences. Amenities of care probably come next, as those are visible outward signs of care to the patient. Technical performance comes in next, because patients don't really have a way to rank technical performance, and then efficiency, because patients have no control over efficiency. Last comes cost-effectiveness, because patients don't pay for that -- they pay a flat rate for their healthcare.

The payer naturally is most concerned with cost effectiveness, which then leads to efficiency as a factor in cost effectiveness. Technical performance is a factor of cost effectiveness, as are amenities of care -- the fewer, the most cost-effective. Responsiveness to patient preferences is famously irrelevant, and there are no interpersonal relationships to speak of.

Society, at least in the U.S., values individual choice, and so responsiveness to patient preferences is a natural outgrowth of that value. Since society is the ultimate payer, efficiency is therefore valued -- leading to "docs in a box" as being cost effective. Management of interpersonal relationships is a subunit of society, as society is composed of interpersonal relationships. Technical performance is irrelevant to society in general, unless egregious harm is done. Amenities of care are also irrelevant, because those are felt on the individual level, and not the societal level.

Question 2a (2. Please list the key points of the law, particularly as it relates to the health care insurance and explain them.

As per the webpage, the healthcare law has 5 parts. The first is rights and protections for consumers in dealing with insurance companies. The second deals with insurance choices, specifically insurance eligibility and purchasing. The third deals with insurance costs -- limitations on insurance companies' use of premiums, for example. The third deals with older Americans and Medicare, including prescription drug coverage. The fourth deals with employer benefits and tax credits, including a limitation on insurance companies' ability to raise premiums. .

Question 2b (2.

Twenty six states are opposed to the Affordable Care Act, including Florida. The Attorneys General of these states have filed suit in Federal Court to overturn portions of the statute. Discuss the Constitutional issues raised by these states and how it will affect the remaining portions of the law.

The lawsuit that most of the opposing states have joined is Florida et al. v. United States Department of Health and Human Services (3:10-CV-91-RV/EMT). Most of the federal laws are based on the "Commerce" clause of the U.S. Consitution, which says that the federal government has the ability to regulate things that affect commerce between the states. The federal government argues that because health care affects the national economy, that they have the ability to regulate health care. States object to the fines for failing to buy health insurance, saying that isn't within the federal ability to tax. Also, states object to the federal assumption of state authority, AKA the requirement to buy health insurance. In addition, states object to an unfunded federal mandate. In the lawsuit, the chief objection is as follows:

Regulation of non-economic activity under the Commerce Clause is possible only through the Necessary and Proper clause. The Necessary and Proper Clause confers supplemental authority only when the means adopted to accomplish an enumerated power are 'appropriate' and are 'plainly adapted to that end,' and are 'consistent with the letter and spirit of the Constitution.' Requiring citizen-to-citizen subsidy or redistribution is contrary to the foundational assumptions of the constitutional compact.

That "citizen to citizen subsidy" is a specific objection to the requirement to buy health insurance, because the justification is that the decision not to buy health insurance makes costs rise for everyone. The argument goes that because the uninsured end up consuming healthcare anyway in the form of ER visits, etc. For which they don't pay . Because hospitals are mandated to see them, they pass the cost along to those who do pay, normally with their health insurance. The chief objection is that the non-activity of not buying health insurance isn't legislatable, because only activity is legislatable. The federal government objected because the uninsured aren't "inactive," because they're still consuming healthcare.

Federal appellate courts are split nearly evenly about supporting or upholding the law. They're mainly divided on whether or not the rest of the law could be separated from the requirement to buy health insurance, generally based along party lines. The current appellate decision allows the requirement to be voided and severed from the law. The Supreme Court has been asked to hear that appeal. Other objections are to Medicaid expansion, which are objected to because states don't wish to fund it, due to lack of funds.