Ethics and Medicaid: a new look at an old problem.
Recent proposals to reform Medicaid, driven primarily by the need for cost containment, rarely pay explicit attention to values. This paper presents the Medicaid Values Framework, the authors' interpretation of a set of societal ideals embodied in Title XIX of the Social Security Amendments of 1965. The Framework comprises seven interlocking values that are stratified into three interdependent tiers--access, quality, and equity. We use the access and equity tiers to analyze treatment of Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) recipients under Medicaid. We document striking inequities in eligibility standards and in funding for the two groups--inequities that unexpectedly fail to translate into marked disparities in access to Medicaid. In conclusion, we comment on why the present inequities exist and why they are ethically unacceptable.
Bach
M L
ML
Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis 55455.
Oberg
C N
CN
Bryant
N A
NA
Boleman
J L
JL
D000385:Aid to Families with Dependent Children; D004608:Eligibility Determination / Q000592:standards; D004992:Ethics, Medical; D035082:Federal Government; D006297:Health Services Accessibility / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D033242:Minors; D008962:Models, Theoretical; D018579:Patient Selection; D037841:Pregnant People; D040841:Resource Allocation; D012935:Social Justice; D012943:Social Security / Q000592:standards; D012945:Social Values; D014481:United States; D035862:Vulnerable Populations