A Case Study Of Financial Health Care and the access to information

A Case Study Of Financial Health Care and the access to information

The access to information regarding the price and quality of healthcare services can be significantly essential to customers to make a better decision on their care. However, it has been surprisingly difficult for most of the customers to obtain such information because there is no transparency of in price within healthcare. The primary concern addresses the fact that patients rarely view the real cost until after they receive the information from the healthcare providers. The price and quality of services often vary considering the type of the provider, which means that higher costs involved do not necessarily mean an equal to the higher quality of care. The understanding of price transparency in healthcare is considered to be a laudable concept making patients to want it. Therefore, the understanding of copayment problem in the case study is essential to consider when it is either an unethical or ethical issue to the patients and would require ultimate investigation from the relevant authority.

Part One; Unethical Issue

The aspect of the co-paying arrangement of health care bills between the patients and provider has been a conflict of interest for many years. The reason for this is because the providers have not been able to offer transparency in their price of services. Moreover, the providers have the opportunity to negotiate the prices provided to their customers. The patients, on the other hand, depends on this agreement since they believe of the influence of their insurers. However, there is a development of price discrimination because they charge their clients differently depending on the contract from the provider. Notably, the provision of information in the current state is limited to the patients and required an effort to establish price elasticity for the patients. Similarly, the use of patient information is considered to weaken the position for demanding higher quality and efficiency because of the wrong prescription on the cost-sharing information (Reinhardt, 2013). As a result, the development of price transparency in healthcare by providers has been significantly expressing the unethical aspect in the provision of proper information on the treatment process within healthcare institutions.

The co-payment problem present unethical issues for the patient given the fact that providers do not uphold on to price transparency. The price for a similar medical service often varies depending on the provider. Conversely, this has led to the development of price elasticity causing severe consequences for consumers in the health care system. Furthermore, the growing evidence on this aspect has contributed to higher spending for the same service in different healthcare institutions. Primarily this is because the development of transparency can assist in mitigating the practice of unethical issues. The reason for this element is because it can combat the provision of additional price variations. The other challenge which makes co-payment to present unethical problem is experienced in providing consumers with better price information that are being difficult to give consumers the information they require to estimate the cost of care accurately.  

The solution to this issue can be crafted to various determinants that can effectively assist in solving the problem. The provision of price transparency in the health system requires some essential measures to be undertaken as an authority involved in the system. Moreover, Medicare can assume a leadership role to make the quality and costs of information which is provided by both the patents and providers to be easily accessible by the public. As a result, initiating public-private partnerships cans be suitable to create multi-payer databases with uniform quality metrics and methodologies of transparency to adjust the current costs and quality of health care (Reinhardt, 2013). Besides, the department of health and human sciences can create a national quality coordination board to be recommended as an institute of medicine. Therefore, the involved parties can establish critical elements to supervise the process of initiating the development of services which meet the standards of the customers. In this regard, this element encourages the incorporation of an improved performance system which can be operated by private insurers and Medicare.

Part Two; Addressing the Ethical Aspect

The development of a co-payment system is an ethical practice in the health care system. The patients and the providers can make agreements based on the terms which suit their capabilities to ensure they meet their demands in the provision of healthcare services. Therefore, the development of price transparency entails various modules which should be put into consideration. For instance, it is addressing variations which, requires the policymakers, payers, and consumers to develop effective techniques, which provide the scope of relevant information (Reinhardt, 2013). Notably, price transparency can assist the patients in making the right decision on their health status. As a result, the appropriate costs determination in regards to accuracy in payments should contain negotiated or discounted prices that are set with their insurer. The case of Gerald did not indicate this part, because it was under the agreement signed by him before accepting the services of his insurer. Consequently, the total amount for the care is addressed to suggest the combination of all billed services for health care procedure. The consumer sharing costs should only be presented with the elaboration of any form of discount recorded as part of the bill when the insurer and the patient had put it as an agreement during their development of service strategy (Sinaiko, & Rosenthal, 2011). Nonetheless, the costs determinant of health care is established to illustrate health plan of patients and the estimated out of pocket costs of the consumers to meet their needs on additional services, which are unexpected during treatment that has separate cost-sharing obligations.

The development of legal issues is considered to be an ethical issue because it has a restriction to give the patients the opportunity to determine negotiation plans. Primarily this is because the contract offered always have clauses that prohibit the customers from accessing the information. The other challenge to providing consumers with better price information is to develop accurate cost sharing estimates (Sinaiko, & Rosenthal, 2011). The information which is shared by the health plans on negotiation prices does not tell the consumer how much they would pay out of their pockets. Conversely, this would only focus on insured consumers to access individualized estimates suggesting just the amount they would pay through the cost-sharing process. Therefore, the development of medical procedures, which entails multiple billed services will only follow the clause form the agreements between the patient and the insurer. The problems which can be experienced is the provision of a medical procedure put up in a single bill of the service. For example, a surgery conducted in the hospital may require the attention of a different specialist. The billing can be added to total the prices on different separate services produced by these specialists to sum them up. As a result, estimated bills can be provided through an accurate total cost summed up together by individualizing the bill to the respective patient.

Conclusively, the development of price transparency in the healthcare system can be viewed in two different perspectives depending on how it is addressed to the people. The ethical aspect is established out of the development of agreement clauses provided when the contract is made. These elements in the arrangement then bind the patients, and the insures to meet their obligations during the provision of services. The unethical component, on the other hand, is also addressing a legitimate concern to express transparency of services provided. For instance, negotiating prices by the provider without telling patients is unethical practice in healthcare services. The case of Gerald is an example which highlights both sides and the measures which should be put into consideration to determine the best services.


Reinhardt, U. E. (2013). The disruptive innovation of price transparency in health care. Jama310(18), 1927-1928.

Sinaiko, A. D., & Rosenthal, M. B. (2011). Increased price transparency in health care—challenges and potential effects. New England Journal of Medicine364(10), 891-894.