Exam 2 Flashcards
What is a “Cadillac” insurance plan? Why is it called that and how is it defined?
Excessively expensive health insurance plans which may be taxed for their disproportionately large costs
Called that because Cadillac’s are luxury cars that provide excessive benefits that aren’t necessary for the cars to fulfil their main purpose. Cadillac plans provide excessive benefits that are not necessary for adequate care.
Defined as employer sponsored insurance plans that exceed $11.200 in premiums per person or $30,150 in premiums per family
Explain the ACA provision to tax Cadillac plans. What was the intention?
Employers pay 40% tax on excessive benefits. The tax kicks in when the insurance plan exceeds the costs defined above.
The tax was intended to reduce federal revenue spending by 3 trillion dollars between 2019-2028 and raise revenue for the ACA
Why do some argue we should repeal the tax?
Having the law will affect average earners who just happen to have expensive plans.
It unintentionally harms people who are chronically ill, geriatric or have a severe disability.
Many would even argue that overspending on health care benefits hardly exists. Employers are not as generous as a decade ago.
Disadvantages workers/families with chronic illnesses and catastrophic experiences, as they very often have high-cost plans at no fault of their own.
Would not eliminate employers providing benefits altogether, as there’s still a tax benefit below the threshold.
Disproportionately puts the working class at a disadvantage whilst benefiting high-income workers.
Maximizes profit instead of reducing health spending.
Employers are transferring more costs to their employees with the justification of tax avoidance.
Why do some argue it should not be repealed?
More “fundraising money” for the ACA- Helps pay for $1 trillion cost of the ACA. Repeal would add another $197 billion to the federal budget deficit.
Reduces the likelihood of unnecessary care being used.
Could help in reducing private health insurance premiums when pushing employers to reduce the cost of their plans.
Those who have health care readily available to them at very low costs are more likely to be less careful and more inclined towards frivolous procedures.
Wages would increase as a result of less money being deducted to go towards high-cost health insurance. (ESI Exclusion)
Provides a window of opportunity for employers to begin attempting to negotiate health care costs lower.
What challenges do families face when it comes to end of life care?
Bearing Witness- Observing the patient’s decline and being helpless to it Experience of Loss-Loss of life of family member, but also of companionship and caregiving role Experiential Issues: Absence of trust lost/stolen belongings Insufficient staff communication Unmet patient needs Reality of death Final communication
What challenges do physicians face when it comes to end of life care?
Patient Preferences
Desire in-person communication, clear and understandable language with adequate time for questions
Can depend on ethnicity, age, Gender
Cultural Barriers
Language Barriers
Expectations about life/death
Religious differences
Physician Characteristics
Demographics, age
Physician Fears
Study by UW Madison showed that fears about patient reactions can affect physician EOL or diagnosis-related conversations
Emotional reaction
Being blamed
Physician Expressing emotion
Language and Medical Interpretation Issues
Patient/Family Religio-Spiritual Beliefs
Doctor’s ignorance of patients’ cultural beliefs or practices
patient/family limited health literacy
Patient/family distrust of healthcare system
What is hospice care?
Care program that focuses on the quality of life for people and their caregivers who are experiencing an advanced, life-limiting illness
Provides care for people in last phases of incurable disease phases of incurable disease so that they may live as fully and comfortably as possible- typically when the individual is expected to live 6 months or less
Hospice is:
A philosophy of care
Treats person rather than the disease
Focuses on quality of life
Surrounds the patient and family with a team of professionals to help
What is palliative care?
Supportive care, symptom management, or comfort care
Care that optimizes comfort by relieving symptoms, pain, and stress (or used for treatment)
Intensive focus on symptom management, psychosocial support, and attention to advance care planning
Improve quality of life
Can begin at diagnosis
Separate from the patient’s medical care team, helps give treatment
Communicates with the medical care team.
How is end of life care paid for?
Medicare
Government will pay as much as 100% of the cost deductible and no copayment
Services of the hospice staff covered
Medical supplies and prescriptions relating to pain and comfort management given (in some cases when at home must pay no more than $5 for each prescription drug)
ONLY IF CONDITIONS ARE MET:
Medicare Part A
Hospice doctor and regular doctor certify you’re terminally ill
Accept palliative care (for comfort) instead of for treatment attempting to cure illness
Sign statement choosing hospice care instead of other medicare-covered benefits to treat illness and other related conditions
If one does not have Medicare coverage but instead has private insurance: Talk to insurance company about eligibility and what deductibles and copayments apply.
Medicaid can provide coverage (varies by state)
Briefly outline and explain the seven main principles of ethical research.
- Social and Clinical Value
answer questions that have significant effect on society/individuals
Answer to question must be valuable enough to justify asking people to accept risk and inconvenience in order to benefit others
Bottom Line: answers to research questions should
contribute to better understanding of health or disease
lead to improvement in prevention, treatment or care for people to be justified - Scientific Validity
Questions answerable?
Research methods valid and feasible?
Study have clear objective?
Study use acceptable principles, methods and reliable practices?
Bottom Line: invalid research = unethical because waste of resources and expose people to risk for no purpose - Fair Subject Selection
Primary basis for recruiting and enrolling = scientific goals of study
Minimize risks
Enhance benefits
Certain demographics should not be excluded without reason or susceptibility risk - Favorable Risk-Benefit Ratio
Risks: physical, psychological, economic or social
Max potential benefits
Ensure potential benefits are proportionate or outweigh the costs - Independent Review
Review panel ensures experiment is ethically acceptable
Free of bias
Protection of volunteers
Favorable risk-benefit ratio
These same groups monitor the study while it is ongoing - Informed Consent
Process that allows individuals to make decision to participate in study
Process involves three steps:
Accurately informing of purpose, methods, risks, benefits and alternatives
Understand info and how relates to clinical situation
Voluntary decision
Exceptions require a proxy decision maker
Child
Adult with Alzheimer’s
Unconscious with head trauma
Limited mental capacity - Respect for potential and enrolled subjects
Respect for privacy/confidentiality
Respect right to withdraw without penalty
Inform participants of new information
Monitor welfare of participants
Remove if necessary
Briefly outline the Nuremberg code and what it was written in response to.
Written as a direct response to the Doctors’ Trial
Main trial at Nuremberg after WWII
Prosecution of doctors conducting human experimentation in Nazi Germany
Conducted by allied powers
Involved 23 defendants, all but 3 accused of murder and torture
Not formally adopted by any legal body
Influential on future guidelines
Informed consent universal (international law)
Focuses on human rights of research subjects
Included 10 ethical guidelines for clinical research trials
Consent, including ‘Legal Capacity to Consent’
“Should be conducted for the good of society”
Right to Withdraw
Ensure protections in place to prevent injury/disability/death
Should be based on knowledge of “history of disease”
Conducted by “scientifically qualified persons”
Explain what happened in the Tuskegee experiments.
Participants: 600 black men
399 were diagnosed with syphilis, 201 were not
Researchers recruited participants by promising free health care
Participants treated for “bad blood”
Study began when there was no known treatment for syphilis
Researches only gave placebos to participants
Physicians don’t treat participants
Penicillin for syphilis 1947
Mid 1960s Peter Buxton: trials unethical and brings to superiors
Superiors dismiss because wanted to track all participants until they died
Study was leaked to the press in 1972 and subsequently ended
After the Tuskegee Study
128 participants died; Syphilis was passed to 59 spouses and 19 children
Survivors received $10 million out-of-court settlement
New guidelines for protection of human subjects
Led to widespread distrust of health care and public health officials in black
Briefly outline the contents and purpose of the Belmont report.
Created in response to the Tuskegee Study Respect for Persons Beneficence Justice Disclosure of Benefits and Risks to Subjects Informed Consent Information Comprehension Voluntariness
Briefly outline the Declaration of Helsinki.
Set of ethical principles developed by the World Medical Association
First version had only around 600 words; newest version had over 2,000
Older versions made distinctions between therapeutic (beneficial to subjects) and non-therapeutic
Shifted to “all medical research” and “additional principles for medical research combined with medical care”
Added Independent Review Committee requirement
Controversial additions:
Guidelines for Placebo-Controlled Trials
Right to Access (includes research results and post-trial care)
Explain how guidelines concerning clinical research ethics have changed over time.
Because of codes, reports, experiments mentioned, things have changed in regards to adherence to ethics in clinical experimentation
For participants:
Participants have more power (right to withdraw from study at any time)
Participants are more informed/respected (informed of potential benefits and risks, remain informed of changes throughout the study)
More respect for human rights of subjects ●
For researchers:
Informed consent of participants is REQUIRED
Risk-Benefit Ratio is assessed to do study
Study goes through ethical review panel (before and during conduction of study)
There is an emphasis on the rights of the participants rather than physician/researchers getting free reign over subjects
