Discussion: Financing of Health Care

With coinciding concerns about health care costs and the imperative to improve quality of care, health care providers and others face difficult decisions in the effort to achieve an appropriate balance. Such decisions often are addressed in the policy arena. How do policymakers evaluate which health care services should be financed through government programs? How do ethics-related questions and other considerations play into this evaluation process? Is it possible to contain costs and provide accessible, high-quality care to all, or is the tension between cost and care inherent in the U.S. health care delivery system? These questions are central to health care financing decisions in the United States.

For this Discussion, you will focus on the policy decision-making process that determines what types of care are covered by public and private insurers and the ethical aspects of such financial decisions.

To prepare:

• Read the case study “Economic Impact of States Declining Medicaid Expansion”  page 190 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.

Solution:

The U.S government officials have repeatedly engaged in debates on cost versus benefits on financing interventions for various life-threatening diseases such as cancer. Considering the Washington Post article, the economic analysis and assessment can be achieved by using the standard measure of the quality-adjusted life years (QALY) which measures two key factors including the patient’s quality of life on a scale in which 0.0=death and 1.0=perfect health, and the number of years of patient’s life expected to extended by the treatment (Trenaman et al., 2017). Therefore, applying QALY in the case of Provenge for prostate cancer treatment will involve multiplication of the value (that is, $93,000) by the number of months of extension of patient’s life which are four, producing $372,000/QALY.  This implies that the medication is considerably expensive and costs the government and insurance company a lot of funds. According to Stein (2010), prostate cancer is most prevalent in older men where 6 out of 10 cases are diagnosed at ages >=65 years whereby the annual mortality rate for prostate cancer is estimated to be 27,000 deaths in every 192,000 prostate cancer patients in the U.S. As such, considering this mortality rate, prostate cancer treatments should not be among the most costly medications. Even though the medical costs are increasing with time, it is crucial for the government to develop programs and policies for reducing this cost without abdication of crucial patient medications…..Please click the icon below to purchase full solution at $5