Access to Ethics

1) There are potential dual (or more) tiers of health care access based on several factors, primarily ability to pay. Read the following summary posted on the Kaiser Foundation daily alerts summarizing a recent article from the New York Times.

2) Discuss the ethics of a multi-tier health care system. Share examples in addition to the dermatology example provided. What are the implications for health care leaders?

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=53545

The New York Times on Monday examined how "dermatology is fast becoming a two-tier business in which higher-paying customers" seeking cosmetic procedures "often receive greater pampering" than "medical patients for whom health insurance pays fixed reimbursement rates."

According to the Times, dermatology is one of the specialties in which patients "are not only willing to pay for quality-of-life treatments that may not be covered by insurance," but also are willing to pay "much more for such treatments than insurers would pay for a medical procedure that takes a similar amount of time." Health insurers typically reimburse a physician $60 to $90 for a visit that includes a full-body skin cancer check, which takes about 10 minutes. Dermatologists might receive $500, paid on the day of treatment, for a Botox injection to the forehead that takes 10 minutes.

The Times reports that some dermatologists have separate waiting and examination rooms for cosmetic and medical patients. In addition, some dermatologists offer additional services -- such as valet parking -- for cosmetic patients. Donald Richey, a California dermatologist, said, "Cosmetic patients have a much more private environment than general medical patients because they expect that," and physicians "are a little bit more sensitive to their needs." Richey said his efforts to cater to cosmetic patients do not hinder the level of care for medical patients and noted that he keeps walk-in times available to see medical...