Patient advocacy at risk: ethical, legal and political dimensions of adverse reimbursement practices in brain injury rehabilitation in the US.
This article examines the relationship between the growing challenge of securing reimbursement for delivering traumatic brain injury rehabilitation in the US and the health providers' duty to advocate for the welfare of patients. Following a discussion of five impediments or barriers to reimbursement--namely, the erosion of private insurance, the insurer's refusal to pay, lack of empirical data to justify rehabilitation as 'medically necessary', financial incentives to abbreviate care, and the ERISA preemption--the article offers a series of recommendations aimed at enhancing patient advocacy. A prominent theme of this article is that health providers cannot forsake their advocacy role and so must be protected from potential penalties imposed by payers for doing so. The degree to which this protection occurs, however, may largely depend on a willingness to agitate for health reform on the state and federal levels.
Banja
J
J
Emory University School of Medicine, Atlanta, Georgia, USA. jbanja@emory.edu
D001930:Brain Injuries / Q000534:rehabilitation*; D004992:Ethics, Medical; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D011057:Politics; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States