The cost of health care in the United States has increased in recent years. Health care providers and policy makers are facing a huge challenge in providing quality health care with the rising health care costs. This paper focuses on the policy decision-making process that determines what types of care provided by private and public insurers and the ethical aspects that surround such financial decisions.
The Medicare Payment Advisory Commission (Med Pac) decides what health care services the Medicare program will and will not cater for. Med Pac determines the treatments, procedures, and medications. Medicare program uses information on the effectiveness of a health care service to make coverage and payment decisions. Medicare does not consider the costs when making such decisions. To improve this decision-making process, Med Pac should identify services that will have equal or almost equal payment rates in the various healthcare settings. These settings include the Hospital Outpatient Departments (HOPDs) and the freestanding physician hospitals. The commission should also adopt shared decision-making process. This process may help to reduce healthcare (O’Malley et al., 2011).
Considering the Washington Post article, it is evident that there is tension between healthcare cost and care. Medicare does not consider costs in making rulings on coverage. However, federal officers are carrying out a review that will make the government decide on whether it will cater for an expensive prostate cancer drug. The Provenge drug is very costly yet it can only prolong life for a few months, raising alarm about its effectiveness. The ruling made against paying for the drug may make pharmaceutical companies shun away from developing cancer drugs. Therefore, when determining health care services that Medicare should or should not pay for, it is important to consider its effectiveness.
MedPAC. (2014, August 28). Medicare Payment Advisory Commission report. Retrieved from MedPAC: http://www.medpac.gov/documents/comment-letters/08282014_comment_letter_2015_pt_b_rule_final.pdf?sfvrsn=0
O'Malley A., Carrier E., Docteur E., Rich E. C. & Shmerling A.C. (2011, September). Policy Options to Encourage Patient-Physician Shared Decision Making. Retrieved from National Institute for Healthcare Reform: http://www.nihcr.org/Shared-Decision-Making
Stein R. (2010, November 8). Review of Prostrate Cancer Drug Provenge renews Medical Cost-benefit Debate. Retrieved from Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2010/11/07/AR2010110705205.html