Problem:
As the case manager, what ethical issues would you deal with in this situation?
How can you advocate for your clients' needs while upholding the dialysis center's policy?
Under what circumstances would it be appropriate or necessary for a health or human services organization to make an economic decision that may contradict its code of ethics?
You are a case manager in a dialysis center. In your position, you enroll and work with clients to help them obtain health care benefits that will pay for hemodialysis. You also arrange for transportation to and from the center and assess the clients' additional social needs.
Because dialysis centers are costly to build and run, many communities do not have dialysis centers. Hemodialysis is performed two or three times a week and can also be costly to clients due to transportation costs. Some people have no choice but to travel a long distance for treatment. Medicare, Medicaid, and other third party payers reimburse dialysis centers for treating patients. However, the reimbursement amount does not always cover the center's costs and some people do not receive any insurance coverage.
To remain profitable, the dialysis center where you work has decided to accept only patients whose insurance coverage pays at least 90% of its costs. The dialysis center is located in a rural county 200 miles from the city.
You are now put in the position of informing current and future clients that they cannot receive dialysis at this center unless they can cover 90% of the costs, either out of pocket or with insurance.