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Ethical Allocation of Resources in Provision of Occupational Therapy Services

Decisions and Actions

Many ethics resources are available to Jeanette. One resource is the Occupational Therapy Code of Ethics. The Code of Ethics is "an aspirational guide to professional conduct when ethical issues surface." Additionally the Code clarifies and applies ethics principles to occupational therapy practice [2]. While the Code of Ethics does not provide a step by step guide for resolution of ethical dilemmas it does assist in framing conflict to assist the practitioner in responsibly addressing identified concerns.

Principle 1.C of the Code requires occupational therapy personnel to "make every effort to advocate for recipients to obtain needed services through available means" [2].

This principle requires Jeanette to work with the family in identifying potential payment sources in order to improve access to clinically indicated services.

First and foremost Jeanette should not deny care based on ability to pay which could be construed as patient abandonment. Instead, she needs to explore other options for payment and offer to continue service delivery on an out-of-pocket basis until alternate funding can be secured.

Unfortunately, occupational therapy services can be quite expensive and many recipients will not be able to afford an out-of-pocket option resulting in a decline of services. If the patient declines treatment, the therapist is not ethically mandated to continue service provision. In fact, the Guidelines to the Occupational Therapy Code of Ethics specifically address pro-bono services, stating these services should only be provided "when consistent with guidelines of the business/facility, third-party payer, or government agency" [1, p. 20]. If Jeanette were to continue providing OT services free of charge she would be in violation of organizational policies and subsequently her profession’s ethical guidelines. However, there are practical options available to Jeanette which may result in reimbursement for services while still maintaining her fiduciary duties to the organization.

Jeanette should communicate directly with the insurance agency to convey that intervention will result in improved functional outcomes which would otherwise not be realized. Since her clinical reasoning supports the need for ongoing therapy she should provide specific information refuting the reason for denial of payment. In addition, Jeanette may need to call the claim processing supervisor in order to directly address noted concerns. Jeanette can also work with her employer to disclose the medical records to the family who also can be working with the insurance company to secure payment.

In these cases, it is imperative that the therapist know what organizational resources exist to assist with overcoming financial barriers. Often referral of clients to the institution’s financial services department may result in a discounted rate, payment plan, or charity care write-off. Jeanette should also look into other community resources that can provide the appropriate interventions, including pro bono clinics in the area. Often local universities provide therapy services free of charge as a means of training students and promoting community service.

Unfortunately secondary to the presence of economic constraints in the current healthcare system not all individuals will receive access to needed services. When the therapist explores all options for funding and services cannot be secured it would be difficult to argue that the provider was in violation of the professional ethics standards related to patient abandonment. Instead the greater issue is one of access and fair allocation of resources.

Ultimately fair allocation of resources needs to be addressed in policy reform. Arguably, healthcare practitioners, including Jeanette, have an ethical obligation to advocate for patients in these public arenas. Therefore, even when services cannot be secured for a specific patient occupational therapists should look to the greater social issues related to justice and advocate at a public level for improved access.

Three of the seven core concepts of occupational therapy practice as outlined in the Ethics Standards would require ethical action by Jeanette at a societal level. Concepts of altruism, equality and justice are intrinsic to occupational therapy practice and thus are values which must be held in high esteem by practitioners [3]. In fact, "it is the professional responsibility of each [occupational therapy provider] to be an advocate for his or her patients and for his or her position in the health care system, and to have the skills to cope with the system" [5, p. 1].

In this case, Jeanette has seen a trend in the reduction of reimbursed visits for pediatric patients by third-party payers. In order to truly address the root cause of the ethical dilemma experienced by Jeanette she should work to promote the just allocation of resources for her patients. Although advocating for access to healthcare at a state and national level may not seem relevant to clinical practice, with the increasing challenge of providing services in today’s healthcare environment advocacy is a role with which practitioners will need to become more comfortable.