Justice is normally thought of more in the courts of law where it is used as a punitive measure for crimes committed. With respect to health care, justice is amongst the key health principles, but possibly the least debated. There are disputes that can occur in health care that needs to be handled through the law. Justice in health care is purposed to enable most people in the world access proper medication. This is despite the presence of set code of conduct that the health care professionals need to follow. According to Butts and Rich, the nurses are allowed to act as per the good of the patient (70). However, the patients have their own rights.
Unfortunately, these rights are mostly violated in the provision of health services by the nurses and doctors. Health insurance is another area in the provision of health care has been violated. Health insurance premiums have been skyrocketing over the years. This has continued to leave most people who are poor unable to check with the health care facilities frequently since they are unable to pay the insurance. According to Stuart and Betar, poor people are not provided with healthcare insurance in jobs that they are doing (para 7). This makes it difficult for a health care organization to recognize them. This is unethical since the healthcare organizations as professions their interest should be the provision of health care services.
As described by the World Health Organization it is every human being fundamental right to enjoy health care of the highest possible standard. However, justice in health care has been in jeopardy for years. There has been strong and consistent evidence about social injustices in health care. According to Morrison and Monagle justice in health care has of recent been very complicated and disputed (45).
The health care administration and health insurance bear the blame for the injustice in health care. The health practitioners have violated patients’ rights in the provision of health care. On the other hand, the insurance policies are biased to benefit the few patients particularly the rich (Rhodes, Battin and Silvers, pp. 107). Currently, health care insurance is unbalanced by design. The insurance premiums are too high for poor people to pay thus rendering medical facilities and care inaccessible to them. There is a lack of universal insurance in most states of the world. Justice in healthcare has limited most people access to proper medication worldwide.
The objective and significance of the study
This research was set to analyze the quality of health care administration. The focus was to put moral thoughtfulness in health care with respect to the administration of health care. In moral acts of thoughtfulness, there is always a dilemma on the action taken by a practitioner administering health care. For instance, when a doctor is compelled to kill a patient that they cannot treat since his/her survival is just a disturbance to the doctors and family. Doctors can use this mandate to take the life of patients with the claim that they are doing it to save them from extensive suffering. Another area of concern in this research was about the quality of health insurance, which has made access to health care facilities impossible for the poor in most parts of the world.
There are various obstacles that hinder value delivery of health care. One of the main obstacles is integrated in the aspect of justice within the health care system. The study of this topic was important to shed more light on a powerful element that is often missing in medical environments. Justice as a health care tool is essential and it is necessary to unveil its’ significance in patient treatment in order to see how the problem of unbalanced health care provision can be solved. In this case, the minorities receive the same health care services as the rest of the people.
This research was guided by the following research question; is there justice in health care?
Definition of Terms
Justice: proper and equal dissemination of health services
Review of Relevant Literature
Justice is commonly heard of in the courts of law where it serves as punishments for committed crimes. Punishment is distributed based on the nature of crime. Similarly to other fields, health care is prone to various disputes or transgressions that require justice. The injustice in health has important variations in its outcome measured in terms of life expectancy, infant mortality, morbidity and so forth depending on the social group. Typically, a low social status group experiences the worst health services hence poor outcomes. The status of a social grouping is defined based on gender, race, occupation and geographic location.
The primary factor that influences justice in health care is the access/provision for health care. Patients have their own rights to access the highest standard of healthcare. Contrary, Kazmier noted that patients have rights of even declining treatment (37). In situations where the patient is showing no progress, doctors force suicide without consulting the patient. Nevertheless, health practitioners are expected to act as per the good of the patient (Butts and Rich, pp. 70).
Unfortunately, these rights are mostly violated in the provision of health services by the health practitioners and insurers. However, the majority of low status patients is unable to access health care due to lack of funds. According to Bodenheimer health care costs “represent a battleground among competing interests” (2005, 848). This limits their potential to pay for health insurance. Additionally, the poor people are not provided with healthcare insurance in jobs that they are employed (Stuart and Betar, para. 1).
This makes it difficult for a health care organization to recognize them. This is unjust since the healthcare organizations as professions their interest should be the provision of health care services. Health insurance premiums increased in demand during the 1930s and 1940s in the United States. This was attributed to antibiotics development and enhancement in anti-infection methods. Health insurance premiums have been increasing over the years. Initially, the Americans mainly relied on employer-sponsored health insurance for protection over the health care costs with the absence of the state’s health insurance (Blumenthal, pp. 82).
Today, the justice in health care is faced with many new challenges. Like before, numbers of Americans who are not uninsured continues to rise. This is attributed to the instability of the economy leading to the bankruptcy and foreclosure of health insurance firms. This has forced employers to shift the burden to their employees whose stagnant incomes limit them to afford health insurance.
The following theories of justice shape this debate. Theory by Norman Daniels explained that the health care goal is maintaining or restoring the normal functioning to the highest possible standard but not beyond. Scholars of social justice stipulated justice in health as to be based on three aspects: equity, equality, and need. According to them, these are the criteria used by people to evaluate justice in the health outcomes. Equity deals with whether the health outcome is deserved depending on the contribution by the person such as paying for the insurance coverage. Equality on the other hand, pertains to the perception of sharing the resources equally regardless of the prior contributions or input by the person.
Lastly, need refers to whether the health outcomes are due to the provision of resources to person’s with the greatest needs. Additionally, the scholars submitted that the above criteria are accompanied by different effects based on the interpersonal relations: equity promotes competition, equality group harmony, and need personal well-being as well as development. Health care distribution can be based on the aspect of need. This is the most common rationing principle of justice in health care argued in various debates.
This research uses qualitative analysis focusing on the administration of health care and operation of healthcare insurance firms. The research is to provide a chronological order of how the problem emerged, progressed and can be solved. The qualitative survey intended to identify the contribution of justice in health care. The qualitative strategies were used in data collection in this study. They include questionnaires, interviews, and observation methods.
This made it possible for observation and identification of characters and their correlation with the variables of the study. In regard to questionnaires, a two sided questionnaire was used. On one side, the questionnaire contained questions measuring the level of justice amongst patients based items on healthcare administration and health insurance plan scales. On the other side, the questionnaire intended to measure the relationship between the health care practitioners/health insurance and patients with respect to justice. Relative to interviews, the study primarily relied on interviews. The participants were interviewed to get the deeper reality about the situation as well as to discover the subjects meaning and understanding. The unstructured interview was used for this research.
In this technique, the interviewer/researcher was fully versed with ideas pertaining to the topics interviewed. Further to the observation, this was the favored qualitative approach which neither obstructs the research nor the methods used in the research. The systematic observation method was preferred for this study. When the questionnaires were administered the respondents were given reasonable time to answer the questionnaires. After the given time elapsed, the research assistants collected the questionnaires from the respondents. Interviews were done in cases where questionnaires were not applicable to ensure no respondent failed to participate.
The participants of this study constituted of 150 patients sampled from hospital in the United States after seeking permission from the relevant agencies and complying with ethical research standards. The criteria for inclusion included: aged18 years and above; either male or female; well versed with justice in health based on a health care setting; person of any nationality, social class, racial or ethnic grouping; someone who had demonstrated evidence of justice in healthcare over the past 12 months; and one ready and willing to take part in the research study.
Qualitative analysis followed concurrently with the process of data collection in this study. This helped to consolidate the accumulating data. Here, the researcher examined the collected interviews transcripts, observations complied, and questionnaires assembled. This took place through highlighting of important points or writing of comments. By so doing, the researcher identified the important points corresponding to the subject under study.
Additionally, this helped to eliminate the inconsistencies and contradictions. Thereafter, data was organized in a systematic way for comparative analysis using statistical tools based on a range of situations, a variety of methods, duration of time and by different analysts. This includes data checking and testing. It also includes the identification of distinctive category elements. Furthermore, it includes the establishment of group generalities. Consulting the secondary data sources was a crucial part of comparative analysis. This helped to reinforce the primary data in order to come up with relevant results.
Out of the 150 sampled participants 72% were women of whom 47% were single, 31% were married, and the remaining 22% comprised of the separated, divorced, or widowed. Additionally, 65% participants were White Americans, 24% Asian-American, 3% Hispanic or Latino, 1% African-American, and 7% were from other racial/ethnic minority groups. This figure of sampling was achieved based on ethnic representation.
Further to employment, 15% of the participants-Latinos and African Americans earned medium annual income between $30,000 and $39,999; 25% less than $20, 000 who comprised participants from other ethnic/racial grouping ; and the remaining 65% reported incomes from $39,999 and above-White and Asian American respectively. Relative to health insurance plans, 50% of the participants were under the Health Maintenance Organization (HMO) plan, 34% Preferred Provider Organization (PPO), 6% Medicare, 3% Department of Veteran Affairs (VA), 2% Fee for Service Plan, 1% Medicaid, and the remaining 4% either had no health insurance plan.
Results and Discussion
First and foremost, it was found that patients use the criteria similar to that used in the legal context to judge fairness in the health care. Women are rated as the ones having the highest interactions with health care representatives and health insurers as opposed to the men. More specifically, white women had more access to the health care services followed by the Asian Americans, Latinos, African Americans and the rest ethnic groupings.
This similar trend is observed in health insurance plans for the patients. These were influenced by the financial capacity of the patients. The HMO and PPO are profit oriented and thus charge higher premiums to the patients. On the other hand, they are highly recognized by health care organizations. The classes represented in these plans are higher income earners mainly the Whites and Asians. The nonprofit plans such as the Medicare and Medicaid have few followers. There is another group of patients who cannot access health insurance plans and struggle much to get access to health care services.
Additionally, the majority of patients attributed justice in health care to be strongly tied to health care providers rather than the Health insurers. This translates to the viewpoint that there is usually a closer relationship between the patients and the health care providers than with the health insurance representatives. As a whole, both the Provider (health care administration) and the Health insurers’ scales proved that they assessed indices relatively dependent with patients’ characteristics mainly finances in the provision of health care. This shows a big disparity which leads to relative conclusion that there is no justice in health care.
Limitations of the Study
Time constraints were a major limitation in this research. This research required ample time to get the appropriate required information. The time allocated for research in the semester was not ideal for such as a research. The selection and researcher’s bias was another major limitation experienced in this study.
Bodenheimer, Thomas. “High and Rising Health Care Costs. Part 1: Seeking An Explanation.” Annals of Internal Medicine, 142, pp. 847-854, 2005. Print.
Blumenthal, David. “Employer-Sponsored Health Insurance in the United States –Origins and Implications.” The New England Journal of Medicine, pp. 82-88, 2006. Print.
Butts, Janie B., and Karen Rich. Nursing Ethics: Across the Curriculum and into Practice. Sudbury, Mass. Toronto: Jones and Bartlett, 2005. Print.
Kazmier, Janice. Introduction to Health Care Law. Clifton Park, NY: Delmar, 2008. Print.
Morrison, Eileen E, and John F. Monagle. Health Care Ethics: Critical Issues for the 21st Century. Sudbury, Mass: Jones and Bartlett Publishers, 2009. Print.
Rhodes, Rosamond, M. Pabst Battin, and Anita Silvers. Medicine and Social Justice: Essays on the Distribution of Health Care. New York, NY: Oxford University Press, 2012. Print.
Stuart, Elizabeth and Thomas Betar. Minorities face hurdles in getting health care. 2012. Web.