Cost Of Health Care Read: Prior To Beginning This Discussion

Cost of Health Care Read: Prior to beginning this discussion, read Chapter 1 and Chapter 3 of your textbook along with the article “Mental health clinician attitudes to the provision of preventive care for chronic disease risk behaviours and association with care provision. â€

As an assistant in arranging discharge planning with a social worker and a multi-disciplinary team, you are asked for your professional input as an elderly woman living alone is being discharged to a long term facility. A high risk procedure and expensive procedure is being suggested for this 87 year old woman. The issue of cost for such procedures for the elderly has surfaced among the team. The team is discussing the decision of the procedure and social services is consulted for a full consideration of the patient in her context.

Paper For Above instruction

Discharge planning for elderly patients, especially those living alone, requires a multidimensional approach that considers medical, psychological, social, and ethical factors. The complex nature of such decisions becomes even more pronounced when high-risk and costly procedures are proposed, raising important questions regarding value assumptions, ethical considerations, resource allocation, and the patient’s wishes.

First and foremost, the value assumptions that influence recommendations in elderly care often stem from societal and cultural beliefs about aging, quality of life, and the allocation of healthcare resources. One core assumption is that extending life at all costs may not be the most compassionate or ethical approach, particularly if the intervention offers limited benefits or diminishes the patient's quality of life (Gawande, 2014). For example, assumptions that aggressive interventions are always desirable may overlook the individual's personal wishes, dignity, and independence. Additionally, societal biases may implicitly favor younger patients or those with better functional status, thus influencing medical decisions that prioritize longevity over comfort or psychological well-being (Levinson et al., 2010).

As a healthcare professional, self-reflection on these value assumptions is critical. Recognizing one’s personal biases—perhaps favoring technological interventions or viewing aging as a period of decline—can facilitate more empathetic and patient-centered decision-making. It is essential to balance professional values such as beneficence and non-maleficence with respect for the patient’s autonomy and dignity. For instance, understanding that the elderly individual’s perception of quality of life might differ from that of medical professionals encourages a more holistic approach. Self-awareness about one's biases helps prevent undue influence on clinical recommendations, thereby aligning care with the patient's own values (Porock & Oliver, 2019).

The high cost of procedures undeniably influences clinical decisions. When healthcare resources are limited and expenditures on prolonging life in the very old are escalating, cost-benefit analyses become integral to ethical decision-making. If the procedure’s expense outweighs its potential benefits, especially in terms of quality-adjusted life years (QALYs), this may justify recommending against it, aligning with health economics principles (Neill et al., 2017). For example, the substantial financial burden associated with costly surgeries may outweigh possible gains, leading clinicians to suggest more conservative, palliative approaches that prioritize comfort and dignity.

However, while economic considerations are essential, they must not override the patient's preferences and values. It is crucial to engage in candid conversations with the patient or their surrogate decision-maker to understand what matters most to them. Does the patient prioritize prolonging life irrespective of cost, or comfort and peace in the final years? Respecting patient autonomy means weighing their desires against medical indications and resource limitations. For example, a patient may decline aggressive procedures if their priority is avoiding pain or maintaining independence, even if the clinical recommendation leans toward intervention.

In this context, the patient’s own wishes should be a central element in decision-making. Even if the recommendation favoring a costly, high-risk procedure aligns with clinical benefits, disregarding the patient’s perspectives would undermine ethical standards. Effective communication is key to ensuring that the patient’s values inform care choices. As health professionals, it is our responsibility to advocate for patient-centered care while also considering broader societal constraints.

Based on these considerations, my recommendation to the team would acknowledge the importance of personalized care grounded in ethical principles. I would suggest conducting a comprehensive advance care planning discussion, including the patient’s wishes, functional status, and quality of life assessments. If the patient values comfort and dignity over prolongation of life, a less invasive or palliative approach may be most appropriate. Conversely, if the patient desires all available avenues to extend life, efforts should be made to ensure that the procedure, despite its costs and risks, aligns with her preferences. Ultimately, shared decision-making, supported by clear and compassionate communication, should guide the final recommendation.

Furthermore, it is imperative that the team consider the ethical implications of resource allocation and societal values around aging and healthcare. Recognizing the potential for ageism or societal biases influencing decision-making helps safeguard respectful, equitable care. Healthcare professionals must remain vigilant to maintain their commitment to responding to the individual needs and wishes of elderly patients, even amid financial and policy constraints (Tinetti & Studenski, 2011).

In conclusion, the decision regarding high-risk, expensive procedures for elderly patients should be rooted in ethical principles, including respect for autonomy, beneficence, non-maleficence, and justice. Decisions must be informed by a thorough understanding of the patient’s personal values, clinical condition, and societal resource limitations, ensuring that care remains compassionate, dignified, and aligned with the patient's own goals and preferences.

References

• Gawande, A. (2014). Being mortal: Medicine and what matters in the end. Metropolitan Books.
• Levinson, W., Kao, A., Keren, R., & D'Aunno, T. (2010). Diffusion of innovative practices and policies in healthcare: Challenges and opportunities. Annals of Internal Medicine, 152(7), 495-503.
• Neill, K. A., Doran, E., & Dore, G. (2017). Economic evaluation in health and medicine. Oxford University Press.
• Porock, D., & Oliver, D. P. (2019). Ethical principles and problem-based learning in nursing education. Journal of Professional Nursing, 35(4), 266-271.
• Tinetti, M. E., & Studenski, S. (2011). Goal-oriented rehabilitation and the elderly. The New England Journal of Medicine, 364(21), e24.