Ethical and Legal Systems of Health Care Organizations Essay Example for Free

Ethical and Legal Systems of Health Care Organizations Essay Aetna Incorporated, a health care plan company, is one of the American leading companies in diversified benefits of a range of traditional and consumer directed health care insurance services. It includes vast service offerings in health care insurance from mental and behavioral health to long-term care benefits and other health-related care and concerns . (Aetna, 2007a; Wikipedia, 2007) Moreover, it is the nation’s pioneer in full-service health insurer that proffers a consumer-oriented health plan. Aetna provides its members with the opportunity to reach out on suitable tools and comprehensible information for them to perform based decisions regarding health and financial interest (Aetna, 2007a). For over 150 years, Aetna has been committed to supporting people in attaining health and financial security. The company establishes information and necessary resources to work for its members and clients for them to execute â€Å"better-informed decisions about their health care. Currently, Aetna membership numbers up to 15. 7 million (M) medical members, around 13. 7 M dental members and around 10. 5 pharmacy members (Aetna, 2007a). In terms of health care networks, it holds on more than 783,000 health care professionals, 458,000 major care doctors and specialists, 4,681 hospitals and a network called AexcelSM, of specialist physicians. Aetna is also the provider of benefits through national employers of small, mid-sized and large multi-state scales in all 50 states, as well as individuals and Medicare recipients in certain markets. Aetna: Code of Conduct The company’s Code of Conduct contains a unique and consistent set of values and standards of integrity and business practices. It mediates in guiding the company in complying with the laws, regulations and ethical standards that controls Aetna’s business functions (Aetna, 2006). According to the preface message of Aetna’s Chairman and Chief Executive Officer (CEO) and President Dr. Ronald A. Williams, every company’s employee, officer, and director is expected to follow the Code of Conduct because: a) it is the expectations of the customers from the company; b) they have a vow to live b their values, and; c) they would be functioning with the utmost principles of fair and ethical business guidelines given that they follow the contained guidelines in all their business aspects. However, the Code cannot cover all situations and Dr. Williams encourages the assistance or guidance of The Aetna Way and their Ethical Decision-Making Framework (to be discussed later in this paper) to conduct sound decisions and take the right actions in performing Aetna business practices. Ethical System The Code of Conduct contains ten (10) specific areas of topics in which the company discusses some policies on specific matters. The first one or Statement 1 deals with Conflicts of Interest that in general regards with the company’s requirement that its employees, officers and directors to keep away form real or obvious conflicts of interest to protect Aetna’s reputation. There should be avoidance in ownership interests or participation in excluded activities that would create a conflict of interest or interference in performing of a job. This requires reporting to the manager and compliance officer for review and sanction of affiliations on hand or ownership concerns that involves him or her or a family member or even a close friend residing in a home such as any positions with any â€Å"business, nonprofit organization or government entity that is an Aetna competitor, customer, provider or supplier† or for other cause or motives that may induce conflict of interest, and; getting hold of a considerable amount of partnership in possession of interest in any business or even partnership. However, the determination of conflicts of interest might sometimes be blurry and hence, guidance of a compliance officer might come necessary. There are also guidelines in the affiliations and interest of the Director and are not far-related to what have been discussed previously, and the review by the Nominating and Corporate Governance Committee must also re regarded relevant. There are also guidelines and rules in accepting or giving gifts; travel, entertainment and honorarium; discounts and preferential treatment; and loans and guarantees of obligations. Statement 2 deals with record-keeping and use of the company’s property and resources which should be entirely legal and proper. This is so since Aetna and any other companies for that matter, is mandatory to submit relevant documents, reports and public communication to the Securities and Exchange Commission and other regulators that also includes disclosure in a manner that is whole, impartial, accurate, timely and comprehensible. All of the company’s resources and property such s e-mail, internet and other computing and communications systems should only be used for the company’s purpose. Bribes and other illegal payments are also strongly discouraged by the company. Statement 3 embarks on fraud, dishonesty and criminal conduct since these apparently affect Aetna’s reputation and continued success. Hence, all business functions must be performed with honesty and with compliance with applicable laws, regulations and ethics rules. Statement 4 is with regards with protecting member and other confidential information of members, employees and the company itself from any inappropriate access, use or disclosure. This is also in integration and compliance with federal and state privacy and security laws that is applicable to the company. Private company information refers to member information, the company’s professional interests, and other relevant information about its clients, subordinates and even suppliers that might be used against the company or for the benefit of its competitor. This is applicable in the course of being under Aetna or after the affiliation with the company. Statement 5 deals with the company’s business and trade practices which should be complied with honesty and integrity since Aetna has its own laws and regulations that apply to the company’s business which are under federal law. The company’s Record and Management Policy is also strongly encouraged to be followed. Statement 6 encourages the company’s subordinates to support Aetna to be a responsible and trustworthy government contractor since the company treasures winning and keeping government contracts. This can be achieved by following federal, state and local laws that regards with government contracting and procurement. Employment laws must be also strictly complied with. The Code is also concerned with proper employment practices and welfare as well as the appropriateness of its workplace (Statement 7). The company complies with policies and programs that ensure the inclusiveness and safety or the workplace for its employees and business partners, promote fairness and respect for all, and promote a working environment where diversity and inclusion are appreciated. Federal laws that discourage discrimination, harassment, special personal relationships, violence and vices are strongly administered by the company. Such laws that are complied with in the company are the Equal Employment Opportunity and the Affirmative Action, which takes away the basing of business decisions on individual’s characters (such as sex, race, color, nationality, age and others; and the company’s very own Alcohol and Drug Policy that prohibits distribution, possession, use, purchase or sell of alcoholic beverages and illegal or prescription substances and drugs. Statement 8 deals with Aetna’s securities transactions which prohibits trade securities if an individual has no material nonpublic information about particular securities. Under this code, all are expected to comply to all insider trading and securities federal laws and the company’s own relevant regulations. Also included dealing and transacting with securities matters and management and secrecy of private information. The company and a subordinate could face civil and criminal consequence for insider trading since insider trading is unethical and unlawful. The statement also discusses on â€Å"material information† relevant in decision-making that concerns any transactions on the company’s securities. Statement 9 deals with the company’s interaction whether private or public to any external institution such as media organizations and even with the federal government. Anyone in close relation to the company and even its subordinates should not speak in behalf of Aetna only there was consent or authorization from the Board of Directors to take such action. Personal views should also be kept separate from the company’s view. He funds of the company should not be also utilized to engage on a lobbyist or to make a political donation except authorized by the Government relations. These are for the protection of Aetna’s reputation and an individual as well, under compliance of laws. Finally, Statement 10 deals with Aetna’s intellectual property. Apparently valuable, such property must be protected from improper use or disclosure whether owned by the company or licensed from others. Intellectual properties of the company must be controlled the legal and proper way. Usage of such property must be under approval of an internal legal counsel and in accordance with the Aetna Intellectual Property Guide. Policies on Aetna’s intellectual properties are also extended to the websites, videos, music and publications. Aetna’s ethical system as contained in its own Code of Conduct presents a vast range of policies that protects the reputation, integrity, security and welfare of both the company itself and its subordinates and members. As discussed above there are specific policies or code of ethics from recordkeeping, employee’s equal opportunity and to intellectual property rights. According to the company, all policies are established in compliance with federal laws. The company’s policies regarding conflicts of interest and confidentiality have general basis as concluded by the study in a position paper from the Society for Health and Human Values and Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation (Aulisio, 2000). One of their conclusions is that, abuse of power and conflicts of interest must be avoided in health care companies. This is so since ethics consultants have the authority and power to influence clinical care and such power can be exploited. Since conflicts of interest can be partial to consultants’ recommendations, important personal or professional linkages with one or more parties should be disclosed and be get rid of. In addition, the personal concerns of the consultants may be affected by giving advice that could act against the company’s financial or public relations concerns. Policies that concern on recordkeeping and use of the company’s property and resources, and insider trading are all in accordance to federal laws specifically in the Securites Exchange Act of 1933 and 1934 (USSEC, 2007). The two basic objectives of the former it that to mandate investors or companies receive financial and other relevant information regarding securities being offered for public sale and forbid â€Å"deceit, misrepresentations, and other fraud† in the sale of securities. The latter states that insider trading is illegal when an individual trades a security while in ownership of nonpublic material information in disobedience of an obligation to withhold the said information or renouncement from trading. On the other hand, policies regarding the company’s employment practices are also observed in compliance with federal employment laws. Federal Equal Employment Opportunity (EEO) Laws prohibit job discrimination which covers almost all private employers, state and local governments, educational institutions and even the federal government (USEEOC, 2005). The said law is enforced by the US Equal Employment Opportunity Commission and also complies with the American College of Healthcare Executives or ACHE (ACHE, 2003). Overall, Aetna covers the essential and core ethic issues in accordance to federal laws.