uniform anatomic gift act
people can have card to grant donation of their organs
-drivers license
national organ transplant act
1984
- united network for organ sharing (UNOS)
- prohibited sale of organs
UNOS
united network of organ sharing
nonprofit - operates system of distributing organs
MELD
model for end stage liver disease
properly give out livers
stages of moral reasoning for doc
pre-convential - black and white
convential - shades of gray
post-convential - no boundaries
david hume
1947 transplant
attached kidney to arm so her kidneys could recover
joe murray
transplant
transplanted kidney between twins
both survived
christiaan barnard
first successful heart transplant
1967
uniform determination of death act
1981
irreversible cessation of circulation or brain function law of land
two focal points transplant ethics
donor and recipient
issues with focal points transplant ethics
scarcity
disparitites
corruption
trafficking
WHO guidelines transplantation
organs removed only with consent
donors and recipient - genetically, legally, emotionally related
organs allocated - clinical criteria
physician determine death should NOT remove organs
NEVER donate organs for money
quality of life
level of satisfaction with life
social roles, physical health, intellectual function, emotional state, life satisfaction
being well
integrity of body
feeling well
quality of life
dax cowart
guy got burned - and blind
keeping him alive, didn’t want it
perspective of patient best sets the standard of medical ethics
conflict of interest
ones obligations vs ones self interest
conflict of obligation
obligation to one group vs. obligation to another group
fiduciary
one who is trusted
rationing
limited care bc of limited resources
economic activity
group possesses a skill or service that is provided to another for a price
economic analysis
study of relationship between demand, supply, and price of economic activity
market failure
failure of an economic system to effectively match supply and demand
often by third party derangement
efficiency
relationship between cost of providing service and outcome it achieves
QALY
quality adjusted years of life
unit of health benefit combining mortality with quality of life considerations
cost-effective analysis
study of cost of treatment to produce desired effect
cost-benefit analysis
study of relationship between cost of service and benefit it supplies
risk benefit analysis
study of relationship between probability of harm in course of therapy and its likely benefits
time trade-off analysis
written instrument used to assess the amount of diminution in quality of life that an individual patient will accept for a therapy likely to extend life by given amount
1960
advent of insurance
managed care
patient care subject to limitation or justification
providers - economic credentialing
fee for service
arrangement where physician provides patient health care services and reimbursed by patient
most incentive for overuse**
incentive to limit care given to each individual
health maintenance organization
health maintenance organization
economic arrangement whereby insurance company pledges to care for all patients health care needs for one premium
PCP acts as gatekeeper to specialists
withhold provision - portion of reimbursement withheld at beginning of each year and only returned if HMO makes profit
PPO
preffered provider organization
insurance company gives patient incentive to use group of providers
capitation
one set fee per month for each patient, regardless of amount of service provided
medicare
individuals over 65
hospitals - part A
physicians - part B
pharmacy - part D
medicaid
low income residents of states
EMTALA
emergency medical treatment and active labor act - 1986
patient anti-dumping act
ER must - conduct screening exam to determine if emergency exists AND stabilize patient before discharge
concierge medicine
boutique medicine
physician paid to be available at any time
unrestricted advocacy vs. restricted advocacy
balance patient preferences, safety, and benefit of treatment, cost effectiveness and cost to patient insurance company
gunshot wounds
reporting is mandatory
societal need for safety supersedes privacy of patient
gifts from industry
less than 100$ only if medical or educational in nature
cannot accept gift that are purely to enhance physician income or entertainment
need to cause harm
to get sued
total cost of healthcare in US
4.6 trillion
20% GDP
bundled payment
care for single health care event is payed all at once
surgery, post op care, rehab all payed for together
global payments
for patients with chronic conditions
encourages continuity of care and coordination among various providers
quality incentives
pay for performance
medical team caring for patient
should not ask for donation
payment for organ donation
only renewable tissues
organ donor card
family consent still necessary for donation
can overrule donor card
average life expectancy
15 yrs shorter in low income countries
greatest strides in average life expectancy at birth
low income countries
mainly due to decreased child mortality rates
US rank world for men and women average life expectancy
not top 10
UK, spain, san marino, new zealand all higher
lower infant mortality rate and under 5 mortality than US
UK
sweden
slovenia
singapore
higher number of physicians per 10,000 population than US
uruguay
ukraine
switzerland
slovakia
GDP spent on healthcare in US
17%
US spends more than what countries (as percent of GDP)
canada
denmark
UK
france
WHO method for analysis of health system performance ranks US
37th
US healthcare
50% private insurance
50% state and federal
uncompensated care
61 billion per year
cost of medicare and medicaid
medicare 524 billion
medicaid 243 billion
total - 767 billion
part C of medicare
medicare advantage
those who can afford to insure themselves can get insurance policy to cover deductible
medicaid
poor >133% poverty line
pregnant women, children, moms
medically needy
nursing home care
medicaid fiscal problems
access - due to low reimbursement
ACA
affordable care act
require insurance by 2014
ACA allow govt panel to make decisions about end of life care
no
ACA expands medicaid to cover low income adults regardless of whether they have children
yes
ACA prohibits insurance companies from denying coverage because of past medical history
yes
business requirement for insurance
if >50 employees
ACA offer new govt run insurance
no
ACA has reduced number of uninsured
yes
sunshine act
tell audience you are getting paid to give speech