In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo

Health Care Needs in the US

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Healthcare Management Capstone in relation to Legal and Ethical Issues in Healthcare

Professor

Date

Ethical Concerns or Problems that Exist Because of the Dominant Form of Employer-Sponsored Health Insurance

One of the main ethical concerns that exist because of employer-sponsored health insurance is the issue of pre-existing conditions. Insurance companies are often reluctant to cover individuals with pre-existing conditions, as they are considered to be high-risk and expensive to insure. This can pose a significant problem for individuals who may require treatment for a condition that they did not previously know about (Nexon, 2020). Another ethical concern is the issue of lifetime caps on coverage. Many insurance plans put a limit on the amount of money that they will pay out over the course of an individual's life, which can leave patients without coverage when they need it the most (Nexon, 2020). Finally, another ethical concern is the way in which insurance companies often handle denials of coverage. Insurance companies have a financial incentive to deny coverage to individuals who are likely to need expensive treatments, and this can often lead to patients being left without the care that they need (Nexon, 2020).

Reform Actions Taken by the U.S. Government to Reduce the Ethical Concerns or Problems Discussed

The Patient Protection and Affordable Care Act, also known as Obamacare, was one of the main reform actions taken by the U.S. government to reduce the ethical concerns surrounding employer-sponsored health insurance. One of the key provisions of this act was the requirement that all insurance plans cover individuals with pre-existing conditions (Nexon, 2020). This provision helped to ensure that individuals with pre-existing conditions would not be denied coverage by their insurance companies. In addition, the Affordable Care Act also prohibited insurance companies from placing lifetime caps on coverage, which helped to ensure that patients would not be left without coverage when they need it the most. Finally, the Affordable Care Act created an appeals process for patients who are denied coverage by their insurance companies, which gave patients a way to fight back if they felt that their coverage had been unjustly denied (Nexon, 2020).

Ethical Principles of Justice and Its Role in the US Health Care System

The ethical principle of justice is the idea that individuals should be treated fairly and impartially, without regard to their race, gender, or socioeconomic status. This principle is important in the U.S. health care system because it helps to ensure that everyone has access to quality care, regardless of their background or circumstances (Brenna & Das, 2021). One way that this principle is enacted in the U.S. health care system is through the concept of Medicaid expansion. Under the Affordable Care Act, states have the option to expand their Medicaid programs to cover individuals with incomes below a certain level. This expansion has helped to ensure that low-income individuals have access to quality health care, regardless of their ability to pay for coverage. In addition, the principle of justice also plays a role in the way that Medicare reimbursement rates are determined (Brenna & Das, 2021). Medicare reimbursement rates are set by the Centers for Medicare and Medicaid Services, and they take into account the costs of providing care in different parts of the country. This ensures that providers in rural areas or other high-cost areas are not unfairly disadvantaged when it comes to reimbursement. Finally, the principle of justice is also important in the way that insurance companies determine premiums and coverage levels. Insurance companies are required to use actuarial tables to determine premiums, which means that they cannot charge higher premiums to individuals based on their age, gender, or health status. This helps to ensure that everyone has access to affordable health insurance (Brenna & Das, 2021).

References

Brenna, C., & Das, S. (2021). The Divided Principle of Justice: Ethical Decision-Making at Surge Capacity. The American Journal of Bioethics, 21(8), 37-39. https://doi.org/10.1080/15265161.2021.1940358.

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