Question

Who should decide when a healthcare procedure is medically necessary: the doctor who is treating the patient, or the health insurance company who is paying the bill? What are the moral and ethical issues concerning the insurance company making these decisions, which are driven by cutting healthcare costs and making a profit?

Answer 1

It is nowadays a common practise that insurance companies are intruding in opting the treatment choice of a patient.

The right to decide whether a procedure is medically necessary is completely in the hands of the doctor who is treating the patient.At the same time the health insurance company who is paying the bill should have the right to audit the patient treatment records and verify the genuinity of the treatments.

if the insurance company is making these decisions,it will cause,

• improper delivery of care:- proper treatment by health care providers are the right of every patient.if an insurance company takes charge,then it will damage the very idea of patient care.declining of insurance claims will be more important than treatment to ailments.
• alter the accessibility by all principle :- the health care of nation should be accessible to all.if a company starts to decide treatment options and their rates,then it will eventually damage the principle of health care to all.
• denial of equitable coverage/limiting treatment options.proceduresa which are rarely done in medical practices may be not included by insurance companies under their coverage.This cause doctors and patients to choose from a limited treatment options.
• economic problems may also be caused if the company deny to pay for the procedure and when the patient has to pay for himself.
• affect care providers:- the health care providers may tend to opt the options given by insurance companies for more patients and more procedures in their account
• adjustments which are not good :- there may be adjustments from doctors and the family members or patient itself regarding treatment options and it will damage the acccuracy of medical/surgical treatment for a particular diesease.
• exclusion from health delivery: cutting health care costs by companies without any discussion with patient or treating doctor will have an impact on a patient's economic status and may affect his treatment choice and thus cause exclusion from health delivery.

other ethical issure includes,

• injustice
• breach of citizen's rights
• inequality
• over use/improper use of power