Health Care Law and Ethics30127, BU 5420.OL 3 creditsPlymouth State University Distance Learning CourseGraduate Spring, 2015

STUDENT NAME: _______Ehtesham Munir___________

Unit 2 Assignment

Exercises:

I. Testing your ability to do internet research:a. You have recently heard of a law that restricts a health insurer's medical loss ratio and want to know more about it. Please look for an authoritative source for the definition of "medical loss ratio" and the link where you found it:

Definition: Medical loss ration measures share of total healthcare premium that is spent on medical benefits as opposed to company expenses such as overheads and profits. It is a statistical measure that gives the fraction of total premium revenue that health plans devote to clinical service, as distinct from administration and profit.

Link: http://fas.org/sgp/crs/misc/R42735.pdf http://content.healthaffairs.org/content/16/4/176.full.pdf

b. Fill in the name and internet address of the regulatory agency that is charged with implementing this law and its description of the medical loss ratio issue: Department of Health and Human services

http://www.hhs.gov

It describes Medical loss ratio as the percentage of total premium dollars that insurance companies spend on providing health care and improving quality of care as opposed to what insurance companies spend on administrative, overheads and marketing costs. A 80/20 or 85/15 rule is applied that mean for small groups 80% of premium is spent on providing healthcare and improving quality of care where by insurers selling to large groups (50> employees)must use 85% of the premium

c. The web page you located above states that the law is part of the Affordable Care Act. Please fill in the applicable Section of the law and the web page where you located it.

Section _________section 2718_Web page: http://www.hhs.gov/healthcare/rights/law/title/i-quality-affordable-health-care.pdf http://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-hios-announcement-memo.pdf http://www.gpo.gov/fdsys/pkg/FR-2012-05-16/pdf/2012-11773.pdf

d. Locate three articles discussing the medical loss ratio rule, as it is incorporated into the Affordable Care Act. Provide the links. 1st article link: http://content.healthaffairs.org/content/16/4/176.full.pdf2nd article link: http://kff.org/health-reform/perspective/beyond-rebates-how-much-are-consumers-saving-from-the-acas-medical-loss-ratio-provision/3rd article link: http://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=3499&context=wmlr

How did you determine that the authors were well informed and that the content was correct?All three articles are from very reliable sources , and were written by experts in there field who provided excellent analysis on different aspects and effects of MLR . The titles accurately defined the article and the problem statements and questions relevant and clearly introduced with literature review and citation relevant to the topic .the analysis and discussion were consistent with the topic and questions raised.

II. Pages 371 and 372 of the text refer to two different standards for determining the adequacy of a practitioners explanation of the risks and benefits of a treatment to a patient for purposes of obtaining the patients informed consent. Assume you are an intern for a state legislator considering whether to pass a state law setting the standard for determining the adequacy of a patients informed consent. Which standard would you advise your boss to adopt? Draft a memo comparing and contrasting the standards and likely consequences of adopting each. Maximum 2 pages single-spaced. Feel free to add your answer to this document, either immediately below or at the end of the document. If at the end of the document, please use a heading.

To: xyz senatorFrom: xyz internDate: 03/12/2015Subject : Regarding different standards patients adequacy of informed consent

When determining adequacy of risks and benefits explanation of treatment given by a physician to obtain informed consent different standards can be applied. The wellbeing of the patient are of utmost importance and to build a level of confidence a full disclosure of information must be made to the patient

Reasonable patient standard or lay standard is based on what the patient understands and needs to know , all the information that can influence his/her decision to go ahead with a treatment or not . the information provided to patient includes all the risks , benefits and consequences of not getting a particular treatment. According to this standard physician must also inform the patient about uncommon and experimental treatments , rare complications even if there is a very remote chance of them happening.Reasonable Physician standard , According to this standard a physician tells you as much as a reasonable physician deems necessary for the patient to make the decision. Under this standard a Physician can exercise a lot of discretion on his part. Physician can choose not to tell the patient about risks that are common knowledge or already known to patient, about unusual/experimental treatments, uncommon/rare risks or physician may withhold certain information if he/she considers patient may withdraw consent to a life saving treatment. But physician must inform about major risks of injury related to treatment and possible alternatives to the treatment, common complications and risks, rare and uncommon complications if they are dangerous.

As times have changed an average patient is more well informed than he/she was few decades ago , we must adopt the reasonable patient standard as it gives patient more autonomy over making a decision as it is the patient who is undergoing a treatment and it is the patients right to know all the risks involved even if the patient refuses treatment he/she will be refusing after evaluating the information regarding consequences of not taking the treatment. A patient may make a bad judgment regarding him/her treatment after receiving information under reasonable patient standard but it is still better than deciding when some of the information was withheld by physician which may have been crucial only if the patient had known.

III. Right now the issue of parents who refuse to have their children immunized is getting a lot if public attention. Public and private schools have long required children to be vaccinated in order to attend. Recently, the issue of requiring vaccines for home-schooled children has been discussed. What is the reasoning behind a requirement to force or encourage parents to have their children vaccinated? Explain how it does or does not fit within the principle 2 that we are free to choose what medical treatments we will receive. Cite any authorities you use to inform your answer. Maximum 1 page, single-spaced.

III. Immunization by vaccines can prevent some of the deadliest diseases and life long sequelae associated with them[footnoteRef:1] .the population cohort that is most susceptible to these diseases are children. There is very strong evidence in medical literature regarding the benefits of vaccination , especially when young children and infants who cannot make decisions regarding there health on there own are denied vaccination they are being denied protection against these deadly disease and most of the evidence used by anti vaccine campaigners is baseless[footnoteRef:2] [footnoteRef:3]. Effect of such anti vaccination campaigns can be seen during recent outbreaks of measles in the US [footnoteRef:4]and how vaccination has helped decrease morbidity and mortality associated with common diseases that have vaccines can be checked by reviewing historical data[footnoteRef:5] and data from any of the third world countries where access to even basic healthcare is not possible. And not to mention that due to vaccines society saves millions of dollars that otherwise would have been used on hospital visits , treatments and lost due to loss of productivity due to disease[footnoteRef:6]. These are some of the reason which makes it important to encourage parents and make it mandatory to vaccinate children most importantly because it saves lives. Requirement to get vaccinated does not Fit into the category of informed consent , a physician is legally required to inform the patient about vaccination and take consent and this provides patient autonomy in decision making but with autonomy there also comes responsibility. The matter of vaccination is more a matter of public health than ones individual choice as not getting vaccinated affects other people too in a community so under public health it becomes an obligation, in such a situation state can act to protect public health and make regulations as long as they meet requirements of the constitution[footnoteRef:7] [footnoteRef:8]. And regarding children when parents consent is necessary under common law but if they are denying the child right better health by [1: Shot@Life, "The Solution: Vaccines," www.shotatlife.org (accessed June 4, 2014)] [2: CDC, "Frequently Asked Questions about Vaccine Safety," www.cdc.gov, Feb. 27, 2014] [3: Nancy Shute, "Report: Vaccines Are Safe, Hazards Few and Far Between," www.npr.org, Aug. 25, 2011] [4: http://www.cdc.gov/measles/cases-outbreaks.html] [5: Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States, Sandra W. Roush, MT, MPH; Trudy V. Murphy, MD; and the Vaccine-Preventable Disease Table Working Group, JAMA. 2007;298(18):2155-2163. doi:10.1001/jama.298.18.2155.] [6: ZhouF, SantoliJ, MessonnierML. et al.Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001.Arch Pediatr Adolesc Med.2005;159(12):1136-1144] [7: Jacobson v. Massachusetts 197 U.S. 11 (19050)] [8: http://allhealth.org/briefingmaterials/King-rethinkinginformedconsent-1943.pdf]

denying him vaccination in that instance state can act [footnoteRef:9].These are few exception to the principle of informed consent . [9: Prince v. Massachusetts, 321 U.S. 158, 64 S.Ct. 438 (1944) ]