ABSTRACT
Medicaid is currently a major source of financing for health care for those with acquired immunodeficiency syndrome (AIDS) and to a lesser extent, for those with other manifestations of human immunodeficiency virus (HIV) infection. It is likely to become even more important in the future. This article focuses on the structure of Medicaid in the context of the HIV epidemic, covering epidemiological issues, eligibility, service coverage and use, and reimbursement. A simple methodology for estimating HIV-related Medicaid costs under alternative assumptions about the future is also explained.
Subject(s)
Acquired Immunodeficiency Syndrome/economics , HIV Infections/economics , Medicaid/statistics & numerical data , Adult , Centers for Medicare and Medicaid Services, U.S. , Costs and Cost Analysis/statistics & numerical data , Disease Outbreaks/economics , Humans , Insurance, Health/statistics & numerical data , Male , United StatesABSTRACT
This article describes an attempt to persuade the members of a presidential commission on ethics in medicine to open a public dialogue on the rationing of medical care. The need for limits on the health care individuals receive, and the reasons why the existing delivery system fails to set such limits in an ethically acceptable manner, were outlined. It was argued that although the term "rationing" is appropriate to describe the process of setting equitable limits, the word generates so much controversy that it is avoided; this very avoidance is an obstacle to the development of sound policy. As an ethics commission, it was argued, the Commission was in a unique position to educate the public about the need for limits, and to defuse some of the controversy surrounding the word rationing. The Commissioners were not persuaded. They accepted the case for limits, in substance, but refused to use the word rationing in their report.
KIE: The major portion of this article originally served as an introduction to a paper the author prepared for the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Baily differentiates between allocating and rationing resources, and between rationing and eliminating waste. She discusses the pros and cons of price and non-price rationing of medical care, and the misconceptions the public has about rationing as it might be practiced in the United States. Finally, she describes the role the Commission could have played in fostering the rationing debate, and its actual response to the issues in its report Securing Access to Health Care.
