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Cost versus care

To resolve conflicting ethical considerations in patient care, cost control and relationships with pharmaceutical companies and other suppliers, they must have both a solid understanding of the issues and a commitment to do the right thing even when it is not easy

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Ethical values direct us in our everyday lives. Healthcare ethics involves making well-researched and considerate decisions about medical treatments while taking into account a patient’s beliefs and wishes regarding all aspects of his health.

Healthcare ethics is a thoughtful exploration of how to act well and make morally good choices based on beliefs and values about life, health, suffering and death. Ethical and legal decisions are made daily by healthcare providers in the performance of their regular duties.

Medical administrators face complex ethical questions every day. They probably face difficult ethical decisions more frequently than just about any other type of professional. To resolve conflicting ethical considerations in patient care, cost control and relationships with pharmaceutical companies and other suppliers, they must have both a solid understanding of the issues and a commitment to do the right thing even when it is not easy.

Some of the most cutting-edge medical technology available are also among the most expensive. The extra cost does not always result in dramatically better outcomes. A Time magazine article from 2016 showed the example of a treatment that gives the patient a 5 percent chance of living for a few extra months. Considering that the treatment will most likely not work and will only give the patient a few months even if it does work, can the expense to get the technology really be justified? Will the administrator put cost ahead of patient care?

Another dilemma commonly faced by healthcare administrators is handling business relationships between doctors and outside providers.

For instance, if a doctor has an arrangement with a pharmaceutical company so that she receives a bonus or consideration of some kind for prescribing its products, she might be inclined to prescribe that medication more often than she really should.

Obviously, this can appear as an act of impropriety. In the Philippines, some hospitals have completely banned medical representatives detailing their products within hospital premises. In the US, some universities have even mandated their medical school faculty to disclose relationships with medical equipment and drug companies.

There are times when administrators have to make tough decisions about doctors or their staff. If a doctor is found to behave inappropriately toward subordinates or patients, it may be necessary to take action before the institution has to deal with a lawsuit or the media. If the doctor is popular or influential or earns top revenues for the hospital, this can be a difficult call to make.

Administrators are reluctant to admit mistakes for fear the admission could end up in media or even in court. Actually, many situations that end up in court could have been resolved more easily with a sincere apology and an improvement process designed to prevent a similar mistake in the future.

As science and technology further increase the abilities of doctors, and breakthroughs open up new modalities in care, the role of healthcare ethics will only continue to increase in importance. It is vital that healthcare administrators be properly trained to meet the current and future challenges of ethically helping patients receive the best care.

With over 30 years of experience in patient care, healthcare marketing, business development and operations, Marilen Tronqued-Lagniton is a Certified Lead Auditor for ISO 9001:2015. She earned a MBA for Healthcare Administrators at the Anderson Graduate School of Management at UCLA; Patient Safety Officer Course, Institute for Healthcare Improvement (IHI, Cambridge MA); Advanced Leadership Course, Kellogg School of Management, Northwestern University (Evanston, IL). Email mtlagniton@gmail.com.

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