Decoding cooperation-oriented protective behavior amid public health crisis: How multidimensional risk communication works.

Broadly speaking, the health insurance industry in the United States has a lengthy history of providing limited support to both patients suffering from chronic pain and those tasked with treating them. There is a clear and troubling absence of an ethical framework guiding health plan decision-making, driven by the fundamental conflict between profit maximization and the obligation to act in patients’ best interests. The largest insurers in the US are publicly traded companies, and they have seen record profits in recent years. Although it has been alleged that payors share clinicians’ goals of positive patient outcomes, this may be an overly generous assessment. For many years, insurers have argued that they have no fiduciary obligations to their enrollees or society, but only to their shareholders. This conception, while typically considered within the context of for-profit private insurance, has also been applied to public health systems such as Medicare, with assertions of the responsibility of protecting its Hospital Insurance Trust Fund. Medicare spending growth has slowed over the past 20 years, with low payment rate increases most apparent following the Affordable Care Act, sequestration policies, and physician payment freezes., However, within the context of Medicare, strong legal arguments are being made for extending fiduciary principles to each patient’s medical well-being, as well as to the system’s financial supporters. Further, this is not solely an American phenomenon, as numerous National Health Services around the world are currently facing severe financial struggles and are consequently rationing care. As such, private and public health systems are exploiting vulnerable populations, with none more evident than chronic pain sufferers.