HCS/545 Version 3 / 2
Weekly Overview
Week Three
Overview
This week we discuss the legal and ethical issues related to supply and demand that affect resource allocation. These issues affect the day-to-day decision making that occurs in health care. We focus on the legal and ethical underpinnings of questions. Where can I get enough people to staff this unit? What contract terms should be included in a temporary staffing contract? What are my obligations under a union contract? Who should be the first to be vaccinated when there are only limited vaccines available? Who should be treated first when there is a disaster or emergency that creates a surge in demand? These are some of the difficult questions we will address this week.
What you will cover
1. Legal Implications on Health Care Resources
a. Evaluate the laws related to health care resource allocation.
1) Limited resources (supply)
2) Health care professional shortages
a) Health care professional shortages (RN)
b) Increased costs for staffing
(1) Health Care Professionals from other countries
c) Sociodemographic changes
3) Limited operations resources
a) Cost of care
b) Cost of medical liability
c) Cost of employee benefits
d) Cost of legislative mandates
e) Budget constraints
f) Reimbursement issues: capitation, reduced reimbursement, etc.
4) Limited supplies
a) Organs
b) Medications, supplies, etc. in a disaster or emergency
5) Limited access to supply
a) Lack of insurance
b) Inability to pay
c) Managed care use review and denials
d) Lack of knowledge to navigate the system
e) Rural limited supply of services
f) Urban inner city and lack of education to navigate the system
6) Demand
a) High quality of care
b) Case mix of population served
c) Sociodemographic changes with aging baby boomers
d) Educated consumers
e) Disaster planning and demand surges
7) Resource allocation
a) Rationing in health care
b) Resource allocation
c) Justice
8) Common health care issues
a) Routine services
b) Preventive care (H1N1 vaccine prioritization)
c) Emergency services (EMTALA)
d) Transplants
e) Biomedical care
f) Disaster planning
g) Managing chronic illness with an aging population
h) Employment laws
(1) Fair Labor Standards Act (FLSA) of 1938: This sets the workweek at 40 hours, and provides for overtime at 1 ½ times base wage, and sets limits on youth workers
(2) Family Medical Leave Act (FMLA) of 1993: This provides for leave time for workers, organizations, and leave reasons that qualify
(3) Labor laws: These laws provide for unions and union negotiations
(4) Norris LaGuardia Act of 1932
(5) National Labor Relations Act (NLRA) of 1935
(6) Taft Hartley Act of 1947
(7) Landrum Griffin Act of 1959
b. Evaluate the impact of legislative policy on resource allocation in the health care industry.
1) Staffing issues
a) Shortages & US government role in providing loan forgiveness programs to students entering fields that have shortages (i.e. nursing)
b) Staffing issues
c) Overworked staff and fatigue and error
d) Understaffing and inability to provide needed services
e) Temp staffing and mistakes due to unfamiliarity with the area
f) Staff training and knowledge of procedures reduces error
g) Emergency staffing and need to reduce area
2) Labor Unions
a) Able to inform policy, and lobby state houses and Congress for better staffing and patient ratios
3) Professional licensure boards and their role (RN boards, medical boards, etc.)
a) Able to encourage, inform, and educate the public and provide incentives to encourage individuals to enter the health professions as needed to fill resource holes
(1) Financing and budgetary issues
(2) Handling uninsured population
(3) Handling non-payment
(4) Staff payroll
(5) Space/Facility Needs/Equipment
(6) Patient rooms
(7) Technology (MRI, CT scans, surgical procedures, etc.)
(8) Patient resources
(9) Medications
(10) Equipment
(11) Organs, etc.
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