Term Paper on "Outsourcing of Medical Services"

Term Paper 12 pages (3403 words) Sources: 14 Style: MLA

[EXCERPT] . . . .

Poor socio-economic background and conditions mixed with the HIV / AIDS crisis can only mean even more socio-economic and political upheaval, the regression of development and the collapse of societies: beginning with families, communities, regions and into subsequently economic social systems. "Likewise, one can rank the importance of quality of care and seriousness of condition for the insured and uninsured, respectively. Thus, there are arrows connecting kind of patient to these two clusters. The quality of care clearly matters differently for the various levels of seriousness, so there is an arrow connecting seriousness of condition to quality of care. The question in the other direction is whether conditions of varying degrees of serious are more or less important for the given levels of quality. Finally, excellent care evidently matters more for self-selected medical tourism than for government-sponsored medical tourism, so there is an arrow connecting the alternatives to the quality-of-care cluster (but not conversely)" (Medical tourism: Outsourcing surgery). Therefore, outsourcing of medical care, mainly expensive surgeries, to Asian countries can be achieved by promoting medical tourism to overcome escalating costs of health care and long waiting periods for underinsured and uninsured Americans.

The disease has reached pandemic proportions worldwide, based on the mammoth devastation that it has induced. In 2006 alone, HIV / AIDS associated illnesses caused the deaths of approximately 3 million people worldwide, including a reported 500-000 children younger than 15 years (NIAD online) (Bennett and Whiteside, 2002). However, it is not altogether a bleak situation. Effective and decisive leadership in developed countries and in Uganda as a ray of hope for the developing world, illustrated the disease can be contained with early organ transplanation. However, while this may be so: containment through preventive strategies and modern day technology in regards to treatment - may insinuate possible solutions - yet the reality is that there are countries in the developing world, from Eastern Europe to Asia and Africa where the disease continues to spread. In other regions, like South of the Sahara, where the disease continues to spread so fast, and so violently, that putting aside human pain and suffering, HIV / AIDS threatens to not merely disrupt but alter and regress a region further into the doldrums of human development. This points to the fact the kidney transplantation is prioritized through a location criteria where people are selected on the basis of where they live. (Bennett and Whiteside, 2002).

Organ transplants can vastly improve patients' quality of life and benefit their families and society in general by restoring an ill and dependent individual to health. On cost benefit analysis transplants prove ultimately cheaper than long-term dialysis by $350,000 per patient on average. However, there are fewer donors than there are needy patients although this should not be the case, because the percentage of willing donors lie in the 70s. This further undermines the requirements of those suffering from HIV. Nonetheless, actual donations languish in the 20s. It is argued that this is due to the misdirected and incoherent legal structure in place. One can suggest that to increase the number of organs for transplantation a presumed consent system should be implemented to close the gap between willing and actual donations. In conjunction with improved coordination this will ameliorate the severe shortage. (Williams, 1999) Such a system is ethically and morally justified. It can be considered that other options under kidney donation such as increased investment in coordination without a change in the default position of deference to relatives, as well as alternatives to kidney donation, such as partial transplanations. They are however problematic both ethically and practically, such that even if the law formally and effectively ensures that all who need organs get them, it would be normatively wrong (Neyhart).

The terms of the relevant law must be subject to critique, because ultimately healthcare workers must work within the existing common law and legislation, even as they seek to save patients from an avoidable early death. The definition of death is problematic. Today the concept of brain death has been adopted by most Western countries. Others suggest however that when the capacity for sentience is irrevocably absent, the minimum criteria for personhood no longer exists, despite the presence of a functioning brain stem. Perhaps it is best to admit that it is impossible to define the moment of death with any certainty or precision, and that the important task therefore is to determine at what point in the process of dying organ retrieval becomes legitimate (Williams, 1999).

The law has specified that the doctor be satisfied that life is extinct before organ retrieval may take place but there is no statutory definition of death, leaving that to a matter of clinical judgment. Standard practice is for two independent doctors to perform two sets of tests to determine brain stem death.

The law is somewhat outdated and prevents the facilitation of a successful program. The current system tries to allow for all possible scenarios. An opt-in system is helpful, but there is no definition of who the person 'lawfully in possession of the body' is, and a verbal intention is only legally valid when it is made in the course of the last illness (Day and Klein 1989). Furthermore if a patient is a willing donor, there is no obligation from a legislative point-of-view to establish a lack of objection on the part of relatives, but in practice it is good practice for any objectives raised by relatives to take priority over what the donors desired.

This seems like a discriminatory and weak 'opt-out' scheme applying where the deceased has left no recorded expression of his or her wishes. The person lawfully in possession of the body is authorized to remove organs for transplantation if reasonable enquiry shows that the deceased did not object to organ removal or that the surviving spouse or any surviving relative has no objection to the use of the organs. Although it is fairly evident why spouses should be invited to express their views, this does not reflect the reality of the situation in which many adults now live - cohabitees or long-term partners now fulfill this role (Williams, 1999).

However, with medical tourism, this can be improved because it is less expensive for patients.

Medical tourism as a niche has emerged from the rapid growth of what has become an industry, where people travel often long distances to overseas countries to obtain medical, dental and surgical care while simultaneously being holidaymakers, in a more conventional sense. It has grown dramatically in recent years primarily because of the high costs of treatment in rich world countries, long waiting lists (for what is not always seen institutionally as priority surgery), the relative affordability of international air travel and favourable economic exchange rates, and the ageing of the often affluent post-war baby-boom generation. It has thus largely reversed an earlier pattern of wealthy patients travelling to rich world centres, such as Harley Street in London (but where tourism was not involved). Growth has been facilitated by the rise of the Internet, and the emergence of new companies, that are not health specialists, but brokers between international patients and hospital networks. It has also grown because of rapidly improving health care systems in some key countries, where new technologies have been adopted (Medical tourism: Sea, sun, sand and y surgery).

More practical considerations also exist. First, the need for sophisticated infrastructure to maintain an opting-out register which does not discriminate against HIV sufferers. But this is a problem of the past century. Today, only Internet access and a computer is necessary. It is no more difficult than maintaining a register for opting-in patients. If the number of donors truly reflects the number that are willing at 70% then it is in fact more efficient to keep a shorter list of those who do not wish to donate, which would constitute only 30% of the population. Secondly, there is a fear of adverse publicity if organs are taken in the face of relatives' objections - but as argued above, these could be taken into account, and public education - moral suasion - could persuade the public of the logic of a need for such a system, to cause a change in social values. For example, when the presumed consent system was implemented in Singapore, statistics showed that more people came forward as donors under a separate legal scheme as a result of heightened public awareness of great need. Even the family was more likely to agree to organ harvesting - the Muslim cadaver belongs to her family, so despite the exemption of Muslims from the presumed consent system, Muslim donations rose as well. Due to the widespread awareness of the merits of organ donation with public education and the support of religious leaders with clear moral grounds for the scheme, social values developed to embrace this medical system. Third, one might ask if resources could be better employed than on the maintenance of such a system -… READ MORE

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