Justice And Allocation Of Scarce Resources

Siena College Taytay CHAPTER VIII: College of Nursing

JUSTICE AND

ALLOCATION OF SCARCE RESOURCES  Health Care in the United States  Medicare The federal Medicare program is a health insurance program for the elderly and disabled. Medicare is administered by the Centers for Medicare and Medicaid Services ("CMS"), which was formerly the Health Care Financing Administration (HCFA). Medicare provides benefits for: • Those who have reached age 65 and are entitled to receive Social Security or Railroad Retirement benefits • Disabled individuals of any age who have received Social Security or Railroad disability benefits for at least two years Other Medicare participants may include: • Persons eligible for Social Security benefits who have end-stage renal disease and require kidney dialysis treatment • Persons over age 65 who are not eligible for either Social Security or Railroad Retirement benefits who purchase monthly Medicare coverage Medicare Part A Hospital Insurance Program This program provides beneficiaries with coverage for mostly hospital-related claims, including: • Inpatient hospital care • Limited post-hospital skilled nursing facility • Home health care • Hospice care Medicare Part B Supplementary Insurance Program This program focuses on medical costs other than hospitalization, such as: • Physician and surgical services • Diagnostic tests • Home health care • Physical, speech and occupational therapy • Medical supplies • Durable medical equipment • Ambulance services • Some preventive care services Enrollment in Part B coverage is optional. Each program requires different deductible and co-payment amounts. Medicare Exclusions Medicare Part A and Part B coverage doesn't include: • Custodial nursing home care • Most outpatient prescription drugs • Routine physical examinations • Routine eye examinations and eyeglasses Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 117-134.

Siena College Taytay CHAPTER VIII: College of Nursing

JUSTICE AND

ALLOCATION OF SCARCE RESOURCES • • • • • •

Hearing examinations and hearing aids Routine dental services Routine foot care and orthopedic shoes Most immunizations Personal convenience items Cosmetic surgery

Medicare Part C Any individual who is entitled to Medicare benefits under Part A and enrolled under Part B may choose from several types of health insurance plans under Medicare Part C (Medicare Choice program) including: • Coordinated Care Plans such as health maintenance organizations ("HMOs"), preferred provider organizations ("PPOs"), and provider-sponsored organizations ("PSOs") • Private Fee-for-Service Plans • Medical Savings Accounts ("MSAs") Medicare Part D Medicare Part D is an optional prescription drug benefit. People who are entitled to benefits under Part A or enrolled in Part B are eligible for Part D. They can enroll in a stand-alone drug plan or private health plan that offers drug coverage. Participants pay a deductible, coinsurance and a monthly premium.  Medicaid Medicaid is a jointly-financed federal-state health care program that provides medical assistance to: • Low-income elderly • The blind or disabled • Families with dependent children *Medicaid is the primary public financing program for long-term nursing home and home care services. Eligibility requirements vary greatly from state to state. All states, however, must provide Medicaid coverage to the categorically eligible. Categorical eligibility is related to economic need and income. States may also provide Medicaid coverage to the medically needy, frequently persons in need of expensive nursing home or hospital care. Generally, Medicaid pays for: • Inpatient and outpatient hospital services • Prescription drugs • Physician services • Laboratory and X-ray services • Custodial nursing home care Benefits vary from state to state, and may also cover: Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 117-134.

Siena College Taytay CHAPTER VIII: College of Nursing

JUSTICE AND

ALLOCATION OF SCARCE RESOURCES Dental care Medical equipment Foot care Optometry services Clinic services Rehabilitative services Transportation to obtain medical care Formal Justice- Any criteria could be used such as age sex, marital status a\landownership provided that the criteria was applied equally in all similar cases. • • • • • • •

Material Justice- Principles that specify relevant characteristics of determine morally relevant criteria in regard to treatment.  Theories of Justies  Egalitarian Theories- emphasize equal access to goods and services. Egalitarians believe that an affluent society as ours must find a new way to provide universal heath care to all its citizens.  Utilitarian Theories- emphasize a mixture of criteria so that public utility is maximized. Public utility is the greatest good for the greatest number. Utilitarian accept that political planning and intervention as methods of redistributing goods and wealth to bring about public utility. Health must be rationed and provided only to those who will benefit most and denied to those who will benefit less such as elderly—Callahan & Lamm.  Libertarian Theories- emphasize personal rights to social and economic liberty.  Managed Care The following are guidelines regarding physician-patient practice: Efforts at cost containment should not place patient welfare at risk Plan coverage should not affect the practitioner’s duty to provide informed consent The practitioner has duty to serve as the patient advocate Patients must assume responsibility for selecting their own health care plan  Two-Tier System and the Decent Minimum Two-Tier System- everyone would be guaranteed coverage for basic care and catastrophic health needs. This coverage of a descent minimum of care would be distributed on the basis of need, with everyone being assured equal access to basic and catastrophic services.  The Oregon Rationing System In 1983, the state of Oregon began work on a controversial plan for the allocation of health care resources. The goal, noble enough, was to provide Medicaid benefits for more people than had previously been covered. One option would obviously be to raise more money for health services, though the corresponding tax increases would have been unpopular. Oregon chose another approach: to make Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 117-134.

Siena College Taytay CHAPTER VIII: College of Nursing

JUSTICE AND

ALLOCATION OF SCARCE RESOURCES fewer services available to an enlarged pool of Medicaid recipients. So, by restricting services, they could afford to grant access to more people.  Lifeboat Ethics- Originated from an American sinking ship in Newfoundland in 1842, wherein utilitarian value of keeping families intact and the duty-oriented value of protecting helpless females in was used to save their lives as the other men included in the life boat jump off for the benefit of others.  Triage- process of allocating scarce resources has been commonly practiced and justified in the crises of war or disaster. The wounded groups will be divided into three groups: 1) walking wounded, 2) fatally wounded, 3) seriously wounded.

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E Publishing Inc. San Juan Metro Manila. 2nd Edition. pp. 117-134.