Question 1 (A Genetic tests-Nursing Paper Examples)
A genetic test may be judged from several different perspectives-scientific, ethical, and economic. How are these perspectives different? Why is it important to understand the differences? Explain each perspective and provide examples.
Genetic tests remain medical tests conducted to identify changes in genes, chromosomes, or proteins. Genetic test results rule out, confirm a suspected genetic condition. Consequently, even evaluate an individual’s chance of developing or passing a genetic disorder to their offspring. From a scientific perspective, DNA remain the instruction manual for human bodies to function and grow. While the nucleotides defines the basic units of DNA, they form letters that make up the instructions, A, T, C, and G. Thus, a complete human genome has a complete set of DNA with six billion nucleotides (Bailey, 2022) (A Genetic tests-Nursing Paper Examples).
The DNA in each body cell remain subdivided into thousands of genes that code for specific traits. More so, such as blood type, hair, or disease susceptibility. Thus, genetic testing remain performed on blood, hair, or amniotic fluid samples. For instance, during a procedure for a buccal smear, the healthcare provider uses cotton. In addition, a brush to obtain a sample of cells from a patient’s checked inner surface. The sample is sent to the laboratory, where the technicians observe it. Moreover, to identify potential chromosomal proteins or DNA depending on the suspected disorder. Besides diagnostic testing, genetic testing takes place in the carrier, prenatal, preimplantation, and forensic testing(A Genetic tests-Nursing Paper Examples).
Although the clinical/scientific importance of genetic testing emerge as mentioned and proven. Hence, the economic perspective evidence remain limited. Genetic testing is currently expensive, although the ultimate costs depend on the availability of test changes. The direct costs entail the actual screening tests, although they remain affected by the changing number of screened cases, the unit cost per case, or both. The long-term financial impact of genetic testing emanates from diagnostic and preventative services uptake. Subsequently, the surveillance activities to detect disease development during early progression may vary (A Genetic tests-Nursing Paper Examples).
For example, in BCRA1 and BCRA2 testing, the surveillance may range from inexpensive self–examination to the high costs incurred. More so, during surgical biopsy or diagnostic imaging (Chamseddine et al., 2022). However, the revenue generated from genetic testing has direct economic benefits for the nation. The indirect economic benefits arise from cost avoidance and the productivity gain of genetic testing. In this case, cost avoidance relates to treatment costs avoided through genetic testing. Consequently, the reducing healthcare expenses for the patients, health facilities, and the government (A Genetic tests-Nursing Paper Examples).
Ethical principles are vital to guiding decision-making during genetic testing. The principles ensure that genetic testing remain applied justly and about human values. Ethical issues relating to autonomy, justice, nonmaleficence, and confidentiality ought to remain upheld in any genetic test (The American College of Obstetricians and Gynecologists, 2019). For instance, familial genetic tests may raise ethical issues relating to confidentiality. A clinician may encounter an ethical dilemma to protect the confidentiality of a person. More so, who consents to a test or to protect the health of another individual or spouse (A Genetic tests-Nursing Paper Examples).
For example, a woman with cancer-predisposing genes may not wish to share the information with relatives who may be patients to the same physician to protect their carrier status. Although physicians have a moral responsibility to protect patients’ confidentiality, they should make decisions that override social considerations. In the provided case, the physician should also consider the entire family’s well-being.
As discussed above, the scientific, ethical, and economic perspectives on genetic testing differ. Scientifically, genetic testing remain conducted to identify changes in genes, chromosomes, or proteins. Genetic test results rule out and confirm a suspected genetic condition. Consequently, even evaluate an individual’s chance of developing or passing a genetic disorder. Besides diagnostic testing, genetic testing remain carried out in the carrier, prenatal, preimplantation, and forensic testing(A Genetic tests-Nursing Paper Examples).
While economic perspectives relate to financial aspects based on the costs of genetic tests or cost savings, the ethical perspective ensures that genetic testing remain used justly and with great regard for human values. Importantly, understanding the differences informs the parties involved on the importance and implications of a genetic test. For instance, healthcare professionals use their scientific knowledge to obtain samples, study, and analyze them to produce crucial results that inform medical decisions (A Genetic tests-Nursing Paper Examples).
The physicians and patients understand important ethical issues through various ethical perspectives and principles involved in genetic testing. For example, physicians can avoid legal and financial implications arising from ethical issues. Nonetheless, the economic perspective allows health providers and consumers to understand a genetic test’s financial implications and make sound healthcare decisions (A Genetic tests-Nursing Paper Examples).
Chamseddine, R. S., Wang, C., Yin, K., Wang, J., Singh, P., Zhou, J., … & Hughes, K. S. (2022). Penetrance of male breast cancer susceptibility genes: A systematic review. Breast Cancer Research and Treatment, 1-8. https://drive.google.com/file/d/1N5FiUMp4aa85WtY1x8p9QehNapkeZKsu/view?pli=1
The American College Obstetricians and Gynecologists (2019). Ethical Issues in Genetic Testing. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2008/06/ethical-issues-in-genetic-testing
Bailey, J. (2022). Nucleosides, Nucleotides, Polynucleotides (RNA and DNA) and the Genetic Code. Inventive Geniuses Who Changed the World: Fifty-Three Great British Scientists and Engineers and Five Centuries of Innovation, 313-340. https://link.springer.com/chapter/10.1007/978-3-030-81381-9_13
Do regional variations in surgeries mean that some physicians overtreat and others undertreat? Do these differences indicate inappropriate and unnecessary care? Explain what is meant by regional variations. Provide examples.
Regional variation in surgery relates to the likelihood of a patient undergoing a surgical procedure majorly depends on where the patient lives rather than their clinical condition or circumstance. In this case, a patient’s probability of undergoing cardiovascular, orthopedic, oncologic, and other operations may vary 3 to 10-fold across different geographical regions (Ward, 2021) (A Genetic tests-Nursing Paper Examples).
The issue of the determinants of regional variation in surgery is multifactorial. In this case, diagnostic processes, illness burden, patient preference, attitude about medical intervention, and illness burden contribute to regional variation in surgery rates. However, current evidence-based research suggests that surgical variation primarily relates to the physician’s belief about the indication for an operation and the patient preferences’ extent of incorporation in care and treatment decisions (A Genetic tests-Nursing Paper Examples).
Regional variation in surgery should be prioritized in the national healthcare reform and strategies to reduce healthcare costs. Wei et al. (2020) assert that regional variation in any form of healthcare reflects unequal access to care that leads to detrimental outcomes to the quality of care and cost of treatment. In surgical variability, many operations depend on the location, such that where a patient resides significantly influences their surgery for a particular condition. In the United States, the variations between high surgery-use areas and low surgery-use areas have up to four times the likelihood of conducting hip and knee arthroplasty (Ward, 2021) (A Genetic tests-Nursing Paper Examples).
The variations are even higher for prostatectomy, carotid endarterectomy, and back surgery. The regional variations have also been reported in Australia, the United Kingdom, Europe, and Canada (Ward, 2021). The variation is greatest for discretionary surgical procedures since they are prophylactic or symptomatic driven and those that address diseases that lack effective non-surgical treatments (A Genetic tests-Nursing Paper Examples).
Importantly, wide regional variation in surgery indicates that many patients remain over-treated or undertreated. Practice variation is a sensitive topic related to equity of healthcare access, which is one of the thresholds for achieving universal coverage in the United States healthcare system. In this case, very low surgery-use areas could imply that the patients are being undertreated. One factor contributing to the low rate of surgeries could indicate that low-surgery use lacks enough personnel or surgeons to provide the required patient services (A Genetic tests-Nursing Paper Examples).
For example, regions known for specific surgical procedures influence younger surgery talents to be taught and trained. Thus, a region’s utilization of specific surgical procedures depends on the practice installed during training that supplies the surgical workforce. The region may also lack enough healthcare facilities that offer surgical healthcare services. Regions with a better supply of surgeons and proper training will likely have better surgical services leading to better health outcomes (Ward, 2021). However, the region may also need more surgical operations leading to ineffective and unaffordable care(A Genetic tests-Nursing Paper Examples).
Technology diffusion also amplifies the surgical variation for surgical services. New approaches to care contribute to variation since healthcare professionals have alternatives to perform operations. As such, patients may receive surgical services owing to the diffusion of a new care approach or lack of sufficient services from a lack of strategies to address new health conditions. Based on a financial perspective, some surgical operations are high in physician-owned hospitals compared to those conducted in hospitals where physicians lack direct financial incentives leading to variation that affects the accessibility of quality care.
Regulatory constraints also dampen the variation in surgical rates. Some regions may have restrictions towards performing certain operations. For example, New York State has limited diffusion of cardiac surgery programs, which may lead to under-treatment of patients requiring specific surgical procedures (Ward, 2021). However, evidence-based interventions will be vital to compare the effectiveness of surgical and non-surgical interventions to mitigate surgical regional variation. Thus, disseminating better-shared decision-making tools will reduce variation in prioritizing sensitive health conditions (A Genetic tests-Nursing Paper Examples).
Ward, M. M. (2022). Regional variation in surgical procedure rates: going beyond description. JAMA surgery, 157(2), 91-92. doi:10.1001/jamasurg.2021.4892
Wei, W., Ulyte, A., Gruebner, O., von Wyl, V., Dressel, H., Brüngger, B., … & Schwenkglenks, M. (2020). Degree of regional variation and effects of health insurance-related factors on utilizing 24 diverse healthcare services- a cross-sectional study. BMC health services research, 20(1), 1-15. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05930-y
Describe the different characteristics of for-profit and not-for-profit hospitals.
While there is no indication of potential differences in environmental, efficiency, operational, and standard of care between for-profit and not-for-profit, the hospitals vary in characteristics such as core objectives, financial strategy, provision of uncompensated care, and liability of malpractice. For-profit hospitals’ core objective is to earn income/ profit for the stakeholders, while not-for-profit hospitals’ main objective is to offer healthcare services to the community (Moon & Shugan, 2020) (A Genetic tests-Nursing Paper Examples).
For-profit hospitals plan their strategic plan and budget and use their profits to pay their stakeholders. Onto the financial strategy, for-profit hospitals pay taxes for the profit they receive from their revenue. The financial needs of for-profit hospitals make them portray cost awareness and operational control to meet the set goal.
On the contrary, not-for-profit hospitals are exempted from taxation while they receive donations and grants to meet their needs. While for-profit hospitals do not have laws that state that they cannot release patients unable to afford care, not-for-profit hospitals must offer care even if patients cannot pay. On the practice liability, for-profit hospitals are liable for legal actions and have no sovereign immunity law. On the other hand, not-for-profit hospitals have sovereign immunity law that protects them from any form of legal action (A Genetic tests-Nursing Paper Examples).
Answer the following: What is the \”medical arms race\”? (Many argue that hospitals are already too competitive in that competition in a not-for-profit environment turns into a \”medical arms race.\”) How has duplication of services affected the provision of hospital care?
The medical arms race is incurred from increased amenities and medical technology costs. The high number of healthcare organizations in the same market area is highly linked to loss of efficiency since the hospitals engage in the medical arms race when faced with competitors (Liu et al., 2022). In the medical arms race, healthcare organizations unnecessarily spend on cost-enhancing technologies, consumer quality improvements, and duplicate amenities to attract more patients and healthcare professionals (A Genetic tests-Nursing Paper Examples).
How has the not-for-profit structure of the hospital industry affected competition?
Tax-exempt non-for-profit health facilities have parent organizations that are non-profit health system corporations and sole members of the subsidiary health facility. In this case, the sole members of a not-for-profit hospital are analogous to the shareholders in for-profit healthcare organizations and reserve the powers traditionally similar to shareholders’ power. Not-for-profit hospitals are exempted from tax and aim to improve communities’ health and well-being. Thus, not-for-profit health facilities have stiffened the competition against for-profit organizations. The competition increases since for-profit hospitals have to expand their available non-profit high-priced premium specialty medical services (A Genetic tests-Nursing Paper Examples).
How has duplication of services affected the provision of hospital care?
Healthcare services encounter challenges when deciding whether to cut, add, or maintain healthcare services in response to the changes in health consumer demand. As such, the problem is elevated further if other healthcare facilities offer the same services in the same area. The rise in hospital competition has led to high duplication rates of healthcare services, such as high-tech, ancillary, and inpatient services. The duplication of inpatient health services is linked with high costs and operating margins (A Genetic tests-Nursing Paper Examples).
Duplication of ancillary services is associated with a high return on assets, while duplicated high-tech services lead to financial losses for health organizations (Liu et al., 2022). Duplication of inpatient and ancillary is linked with positive returns compared to high-tech services that result from the medical arms race. Thus, healthcare facilities should examine and re-examine the costs and benefits of offering high-tech services that other local facilities offer to mitigate potential losses (A Genetic tests-Nursing Paper Examples).
Discuss whether the non-for-profit hospital status eliminates the for-profit behavior.
Non-profit hospitals eliminate for-profit behavior. The current trend in the number of non-profit healthcare facilities in the United States portrays that trend as gaining popularity and acceptance among the public. By 2022, the United States had about 3000 non-profit hospitals. In this case, there was a likelihood that a patient in need of healthcare services such as ambulatory care and sand inpatient surgery care had a high probability of landing in a not-for-profit health facility (Moon & Shugan, 2020) (A Genetic tests-Nursing Paper Examples).
Subsequently, not-for-profit healthcare facilities have gained community acceptance by prioritizing health consumers’ needs. Patients’ main aim is to receive the best available care offered by non-profit healthcare facilities since the main aim is to obtain the best outcome for the patients. Non-profit hospitals offer a wide range of services, such as neonatal ICUs, that may not even generate any profits and plan for the long-term future promoting greater acceptance by diverse health stakeholders over for-profit organizations (A Genetic tests-Nursing Paper Examples).
Liu, P., Gong, X., Yao, Q., & Liu, Q. (2022). Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009–2013. Cost Effectiveness and Resource Allocation, 20(1), 73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9791778/
Moon, J., & Shugan, S. M. (2020). Non-profit versus for-profit health care competition: How service mix makes non-profit hospitals more profitable. Journal of Marketing Research, 57(2), 193-210. http://bear.warrington.ufl.edu/centers/mks/nonprofit-healthcare.pdf