198294 Ethical implications of quality of health insurance service delivery: A case study of kidney transplantation

Tuesday, November 10, 2009: 4:30 PM

Elisa Gordon, PhD, MPH , Institute for Healthcare Studies, Northwestern University, Chicago, IL
Much attention has been devoted to improving access to care as an ethical requisite to ensure quality care. However, there has been little discussion of ethical implications of the quality of patients' interactions with insurers, which are critical to gaining access to care. This paper describes how kidney recipients evaluated their experiences interacting with their insurers, and the kinds of difficulties they routinely encountered with insurance agencies. Kidney transplant recipients are an ideal patient population to consider because of their frequent interactions with insurers given their long-term reliance on insurance coverage for anti-rejection drugs. Anti-rejection medications are costly and must be taken for life of the kidney graft to ensure graft survival, yet most patients cannot afford them without insurance coverage. A consecutive cohort of kidney recipients (n=88) participated in a semi-structured interview. A third of patients (34%) reported a negative experience interacting with their insurer, and most (72%) reported a neutral or positive experience. Leading negative experiences pertained to problems with poor and rude communication, hassles involved in processing paperwork, and the time-consuming application process. Positive experiences related to having good coverage, simple application process, and having no problems or minimal interactions to date. Findings suggest that even when patients have insurance coverage, difficult interactions with insurers limit their ability to obtain necessary care and medications. These problems raise ethical concerns about preventing the waste of transplants, which are scarce societal resources. Patients' perspectives on the delivery of service by insurers should be included as a quality indicator.

Learning Objectives:
1. Describe positive and negative interactions patients experienced with insurers and their affect on patientsí access to health care. 2. Analyze the ethical ramifications of insurance interactions on kidney recipientsí efforts to prevent waste of scarce organ transplants 3. Develop patient-centered perspectives in quality care indicators of insurance service delivery.

Keywords: Quality of Care, Insurance-Related Barriers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have no conflict of interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.