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Back to Main PageIntroduction: "Equitable Access" means that people are guaranteed the same level of health care as other people. What is available to one person is available to everybody, and so on. Normally this would apply up to a set limit of minimal health care. One would have to pay for anything beyond that. James Todd is one proponent of this system. He claims we should "define a basic level of health care to which everyone is entitled, supported by multiple funding systems." Todd suggests adding a government subsidy for people who are above the poverty line, but who cannot afford necessary treatment. Another concept of "equitable access" allocates treatment based on medical needs and the resulting benefits. This might not mean everybody will get the same types of treatment, but instead it will be equal relative to the resources available, the health of the individual, and the expected outcome of treatment. Thus, everyone is guaranteed an "adequate" level of treatment, but not necessarily the same type or amount of treatment as somebody else. Needless to say, "equal" access based on benefit would minimize the care given to the elderly or terminally ill. Their expected benefit would be less than that of someone younger. Below are some examples of Inequality in Health Care, stemming from prejudice, misunderstanding, and society's reluctance to deal with certain types of people. Sometimes we neglect people because we feel they "don't deserve" care, or because the costs of care outweigh the benefits. The notion of equal access requires that we abandon our personal judgments and fulfill our societal obligation to others. Back to Top |
Patients of Uncertain Life Expectancy Lack Care Patients dying of diseases of unpredictable life course are being denied hospice care. This reflects a growing trend in our health care system. Insurance companies and HMO's are less willing to cover individuals who are likely to develop costly medical conditions. In effect, patients are being denied access to medical care just when they need it most. This tactic has helped insurers to cut costs, at the expense of human life. (See "Cost") As the life expectancies of patients with chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease and end-stage liver disease are "nearly impossible to predict with any accuracy," many of those patients may have been denied Medicare hospice benefits, according to a study in today's Journal of the American Medical Association. Government guidelines require that a doctor and hospice director certify that a patient has no more than six months to live before granting Medicare hospice benefits. The
researchers note that a "likely implication
of this study is Back to Top |
HEALTH
CARE BEHIND PRISON BARS PLAGUED BY Washington, D.C., Sept. 1, 1999-The 5.9 million Americans in jail, prison, on parole or on probation may represent the only population group entitled to appropriate medical care while under state supervision. But the delivery of health care in the country's correctional systems is not cost-effective, it is not adequate in quality and it does not serve the public interest. According to the lead article in a
special issue of the Journal of Health Care Finance, Pollack said inmates are "out of sight and out of mind" as far as the general public is concerned "yet their health care challenges deserve public attention. We have to decide whether criminal offenders are individuals, who merely require supervision, or they are individuals who require treatment for their health care needs in substance abuse, HIV and other disorders while they are entirely under state supervision. Correctional institutions have not addressed either viewpoint satisfactorily." "This is an extreme
example of the problems of correctional care. Altice adds "if we provide inadequate medical care to inmates with substance abuse and other behavioral health problems, we lose the opportunity to prevent predictably dangerous and costly behaviors, both within the correctional facilities as well as within the general community where large numbers of probationers and parolees are found. Criminals often face substance abuse-related problems, including sexually transmitted diseases, HIV, and tuberculosis. "Managed care can provide some solutions, but at least one aspect of managed care, strongly capitated payment, is likely to produce unacceptable risks in providing adequate care to supervised offenders." "Supervised offenders do
not use health care in the same way as the "These inmates face barriers in accessing health care services. In the general community, most managed care patients can obtain 'out-of-network' care, through increased co-payments and other costs. These options are not available in most correctional settings, and because prisoners lack mobility, they often lack access to services easily obtained by other patients." According to the article, providing continuity
of medical care is another major problem for
correctional institutions. Upon entering a jail or a
prison, most inmates are disenrolled from Medicaid after
the first month of incarceration. Few states have
mechanisms to assure appropriate re-enrollment upon
release from jail. Back to Top |
| Seniors
Hardest Hit by HMO Withdrawal There has been a recent rash of HMO withdrawals from Medicare and service cutbacks intended by many more. "Most 'orphaned' Medicare
beneficiaries have been able to find new coverage
arrangements, Over 400,000 Medicare HMO enrollees have been forcibly dropped from their HMOs. The survey found that two-thirds of disenrollees had joined other Medicare HMOs, while the remainder had returned to traditional fee-for-service plans with or without supplemental coverage. Almost 40% faced higher premiums, and over one-third of all disenrollees received fewer benefits. The most common result was that beneficiaries lost their prescription drug coverage, with one in six reporting no drug benefits after the transition. "The findings make it clear that while all beneficiaries are fortunate to have traditional Medicare as a safety net, gaps in the benefit package meant fewer benefits and high cost for many HMO disenrollees. Low-income,
disabled and those beneficiaries most in need of care
were Continuity of care was
also affected by recent events, the study shows,
revealing that 22% of beneficiaries were forced to switch
doctors. "Interestingly, though not surprisingly,
those who enrolled in new HMOs were more likely to change
doctors," Langwell explained, citing differing
provider networks as the cause. Back to Top |
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