A potential ethical dilemma that I may face when I become a Nurse Practitioner (NP) would be the impact of the insurance reimbursement on the healthcare delivery. As a registered nurse (RN) working in an acute care hospital, the main objective would be to deliver the best bedside care possible to the patients, insurance reimbursement is not a main issue a RN has to worry about on the floor . However, as a NP, I have to think about issues like the patient’s insurance policy coverage on the diagnostic test deemed required or the types of medication. NPs have to have to pay attentions to the insurance coverage so that the patient would not be over burdened with the out-of-pocket expenses. Ethical dilemma situation and solutions
One possible ethical dilemma would be a medication that has been proven to be effective in treating a patient’s disease but has not been approved by the patient’s insurance company. As a healthcare provider, I wish to give the best medical care to the patient but the dilemma would be patient would not be able to afford the cost of the medication without insurance reimbursement. To solve the problem, I can contact pharmaceutical companies for their patient assistance programs, patient and healthcare provider communication is strongly associated with the use of the programs (Gellad et al., 2011). Other possible solutions could be engaging social workers to assist patients to participate in Medicare Part D and financial assistance. We can also collaborate with other non-profit organizations for resources with prescription costs. Potential cost and benefits to the solutions
The process of obtaining medical assistance program, Medical Part D and financial assistance from non-profit organizations can be labor intensive and time consuming. Patients may not be approved for the assistance and the medical condition might be worsen overtime. However, the benefits can be really rewarding when the assistance approved and patients’ condition improve due to the right medication prescribed. Potential oppositions
While the solutions might benefits the patients, extra cost will be incurred for the healthcare facilities to hire extra personnel to follow up with the cases that might not bring financial rewards to the healthcare facilities. “Goals of reduced expenditures and services and increased efficiency, although important, may compete with enhanced quality of life for patients and improved treatment and care, creating tension between providers and administrators.” (Hamric et al., 2014, p331).
Gellad, W., Huskamp H., Li A., Zhang Y., & Gelb S. Use of Prescription Drug Samples and Patient Assistance Programs, and the Role of Doctor–Patient Communication. Journal of General Internal Medicine. July 2011, 1458-1464. Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: an integrative approach (5th ed.). St. Louis, MO: Elsevier.