The tenuous nature of the Medicaid entitlement.
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Although Medicaid is regarded as a federal entitlement program, nowhere does the Medicaid statute explicitly recognize a federal right of action to enforce recipients' rights. Arguably, the Supreme Court, rather than Congress, first recognized the right of Medicaid recipients to protection of federal law. A controversial 2001 federal court decision, however, called into question the continuing existence of federally enforceable Medicaid rights. Although this decision has been reversed, it illuminates the tenuous nature of the Medicaid entitlement, as do recent Supreme Court decisions narrowing federal rights. Congress should amend the Medicaid statute to ensure the rights of Medicaid recipients. (+info)
Views of practicing dentists regarding a mandatory fifth year of training.
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As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years. (+info)
Modified mandated choice for organ procurement.
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Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing the procurement rate. In this paper, we meet the main objections to mandated choice (namely that it undermines autonomy and that mandated donation is preferable). We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation. (+info)
HIV prevention and the two faces of partner notification.
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In the cases of medical patients with sexually transmitted diseases (particularly those with the human immunodeficiency virus), two distinct approaches exist to notifying sexual and/or needle-sharing partners of possible risk. Each approach has its own history (including unique practical problems of implementation) and provokes its own ethical dilemmas. The first approach--the moral "duty to warn"--arose out of clinical situations in which a physician knew the identity of a person deemed to be at risk. The second approach--that of contact tracing--emerged from sexually transmitted disease control programs in which the clinician typically did not know the identity of those who might have been exposed. Confusion between the two approaches has led many to mistake processes that are fundamentally voluntary as mandatory and those that respect confidentiality as invasive of privacy. In the context of the AIDS epidemic and the vicissitudes of the two approaches, we describe the complex problems of partner notification and underscore the ethical and political contexts within which policy decisions have been made. (+info)
Screening for phenylketonuria in a totalitarian state.
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Living under a totalitarian regime has many effects on the structure, way of thinking, and relations in a society. However, it is the impact on neonatal genetic screening that we discuss in this paper. Genetic screening functions at the interface between health services and society at large. Being involved for over a decade in setting up the Bulgarian PKU screening programme, we have had to deal with ways and attitudes which may be difficult for the western mind to grasp. Yet comprehension is very much needed in the new world we are trying to create. (+info)
Mandated treatment in the community for people with mental disorders.
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Commitment to community-based mental health treatment bears limited resemblance to commitment to treatment in a closed institution. It can be better understood in the context of a broad movement to apply leverage to induce treatment engagement, a movement that includes use of the social welfare and justice systems and psychiatric advance directives. Understanding "mandated community treatment" in all of its forms can be advanced by viewing it within the framework of health care quality as recently outlined by the Institute of Medicine, particularly along the dimension of patient-centeredness. (+info)
Winners and losers: expansion of insurance coverage in Russia in the 1990s.
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OBJECTIVES: This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage. METHODS: Data from successive waves of the Russian Longitudinal Monitoring Survey (1992-2000) were analyzed. RESULTS: Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country's citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg. CONCLUSIONS: The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies. (+info)
The impact of Medicaid managed care on pregnant women in Ohio: a cohort analysis.
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OBJECTIVE: To examine the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. DATA SOURCES/STUDY SETTING: Linked birth certificate and Medicaid enrollment data from July 1993 to June 1998 in 10 Ohio counties, 6 that implemented mandatory HMO enrollment, and 4 with low levels of voluntary enrollment (under 15 percent). Cuyahoga County (Cleveland) is analyzed separately; the other mandatory counties and the voluntary counties are grouped for analysis, due to small sample sizes. Study Design. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. County of residence is the primary indicator of managed care status, since, in Ohio, women are allowed to "opt out" of HMO enrollment in mandatory counties in certain circumstances, leading to selection. As a secondary analysis, we compare women according to their HMO enrollment status at the first and second birth. DATA COLLECTION/EXTRACTION METHODS: Linked birth certificate/enrollment data were used to identify 4,917 women with two deliveries covered by Medicaid, one prior to the implementation of mandatory HMO enrollment (mid-1996) and one following implementation. Data for individual births were linked over time using a scrambled maternal Medicaid identification number. PRINCIPAL FINDINGS: The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared to women in voluntary counties. Women residing in all the mandatory counties were less likely to have a repeat C-section. There were no effects on infant birth weight. The effects of women's own managed care status were inconsistent depending on the outcome examined; an interpretation of these results is hampered by selection issues. Changes over time in outcomes, both positive and negative, were more pronounced for African American women. CONCLUSIONS: With careful implementation and attention to women's individual differences as in Ohio, outcomes for pregnant women may improve with Medicaid managed care implementation. Quality monitoring should continue as Medicaid managed care becomes more widespread. More research is needed to identify the types of health maintenance organization activities that lead to improved outcomes. (+info)