Types of Consent and Payers
Part 1
| Type of consent | Define the type of consent (20 to 45 words) | Identify 4 principles of consent (20 to 45 words) | Describe the impact of consent on the health care industry (45 to 90 words). |
| Informed consent | The process through which a patient learns and understands the purpose, benefits, and potential risks of medical intervention such as a clinical trial. The patient then decides to receive treatment or participate in medical intervention. | A patient must have the capability to make a decision.The care provider must disclose comprehensive and accurate information including the potential benefits and risks of the treatment.A patient must have a good understanding of important and relevant information. A patient must be willing to give consent. | Informed consent ensures a good understanding between doctors and patients by creating an effective trust relationship. It also reduces the potential risks and consequences related to various medical interventions. Moreover, informed consent enables physicians to face less risk of legal actions when medical intervention has failed, as it is entirely based on their choices. |
| Implied consent | Is a non-formal agreement by a patient to allow disclosure of personal health information (PHI), primarily expressed through the patients’ actions, facts, and circumstances of a particular situation. | Having general knowledge of what is required for treatment.No formal agreement to allow treatment.The presence of non-verbal communication.Refusal for treatment is not apparent. | Implied consent is common in various health facilities. It is evident when patients’ present themselves to the physicians, apparently aware of what the focus will be. For instance, when a patient presents him/herself to a dentist with a primary focus on the patient’s teeth and oral cavity to examine the problem. |
Question One
There are some instances when physicians do not need to obtain patients’ consent before engaging them in any form of medical treatment. These instances include emergency situations, when the patients’ asked not to be informed, therapeutic privilege, and when the risks are commonly known. In emergency situations, when the patient may not be in a position to give informed consent, and his/her condition presents a risk to damage or may lead to death, the healthcare provider is obliged to treat the patient. In case a patient asked not to be informed and therapeutic privilege, he/she may not be interested in knowing the risk of his/her conditions as it may lead or worsen the patient’s present conditions. Furthermore, a patient does not need to be informed on common issues such as swallowing a pill may not lead to choking. As such, the care provider has the right to provide treatment.
Question Two
Under normal circumstances, physicians often make sure that the patients are comprehensively informed of the benefits, potential risks, and purpose of a test or treatment. This is to enable them to make voluntary decisions before being engaged in any course of medical action or treatment. Whenever physicians are unable to obtain a patient’s consent, a surrogate decision maker is usually identified to make decisions for the patient. Moreover, in emergency situations, health professionals may have to make decisions for the patient’s best interest due to the ethical obligation such as protecting the public’s health.
Question Three
One exception to informed consent in my state pertains to minors. Physicians are obliged to offer treatment to minor patients based on their ethical decisions, whenever they perceive that an attempt to secure consent from their parents or guardians may be impossible and certainly lead to delay of treatment or increase the risk of death. Another exception of informed consent in my state pertains emergency situations. Physicians are obliged to act in accordance to their decisions to save the patients’ life because it is hard to secure the patients’ informed consent in such a situation (Nijhawan et al., 2013).
Part 2
| Identify 3 third-party payers. | Describe the third-party payer (20 to 45 words). | Describe the legal issues that regulate the third-party payer (45 to 90 words). | Describe an applicable law that regulates the third-party payer (45 to 90 words). | Describe the impact that the legal issue and applicable laws have on the third-party payers (45 to 90 words). |
| 1. Medicare | Public health insurance programs that specifically covers those aged 65 years and above with disease, as well as population living with disabilities. It is organized by the federal government. | Coverage options are one of the legal issues that regulate the third-party payer as it often hinders the consistency of policies essential in promoting improved performance in the health industry. Medicare beneficiaries are also basically affected by the quality and safety problem, which is affecting all the patients in the U.S health system. | HIPAA is one of the laws that govern this insurance program. The federal law covers any violations that the enrolled population may be subjected to. The law is formulated by the Centers for Medicaid and Medicare services and provided to all states. The Centers makes sure the states abide by the rules. | As a result of the coverage options, making treatment rather than spending it in something many of the Americans cannot afford due to the rapid increasing fees. This has created a bad situation for the Americans. Another impact is that people spend more money to file lawsuits for an injury received while more productive. |
| 2. Medicaid | Medicaid is federal health insurance created for Americans who have little or no income. Moreover, if an individuals’ income exceeds the state’s Medicaid income, one might still be eligible for this program depending on the medical needs. | The Affordable Care Act has stemmed the expansion of the Medicaid program. Americans are able to get health services at less cost. Moreover, people enrolled for Medicaid are ineligible for certain subsidies that are available through private insurances. However, the program has encountered many challenges brought about by ObamaCare. | The Health Information Technology for Economic and Clinical Health Act (“HITECH”) was signed into law in 2009 to strengthen HIPAA rule. HITECH in relation to the Genetic Information Non-discrimination Act enables the protection of an individual from being discriminated based on his or her genetic information. | The Affordable Care Act initiated the initial implementation and expansion of the Medicaid program. As such, many Americans have been able to access healthcare services at lower costs (Oberg & Polich, 1988). However, it has hindered people who have been enrolled with the insurance program from benefiting from the subsidies often available from the private insurances. |
| 3. Blue Cross/ Blue Shield | It is a private insurer, and its customers include large companies as well as individuals. It is one of the largest private insurances in the U.S. | Blue Cross Blue Shield cover both the Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. HMO offers a wide range of services to its members. A member is required to choose a physician who would be able to manage his/her care. Besides, based on the patient-centered reimbursement criteria, the performance of the physicians can be evaluated and examined. | Patient Protection and Affordable Care Act (PPACA) of 2010 has mandated coverage of preventative services such as immunizations, alcohol misuse screening and counseling, obesity screening and counseling, tobacco use screening, and pregnancy services. Obama put this law into place to allow every insured American the right to access preventive care. | The Patient Protection and Affordable Care Act (PPACA) of 2010 has significantly affected the third payers. Many of the organizations that provide health insurances to their employees have felt the significant hit of this law and has increased the deductibles and premium rates. As such, health care cost has also increased. |
References
Nijhawan, L. P., Janodia, M. D., Muddukrishna, B. S., Bhat, K. M., Bairy, K. L., Udupa, N., & Musmade, P. B. (2013). Informed consent: Issues and challenges. Journal of Advanced Pharmaceutical Technology & Research, 4(3), 134. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777303/
Oberg, C. N., & Polich, C. L. (1988). Medicaid: Entering the third decade. Health affairs, 7(4), 83-96. Retrieved from https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.7.4.83