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CHAPTER VIII:
College of Nursing JUSTICE AND
ALLOCATION OF SCARCE RESOURCES
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 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
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.
• 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.
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
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
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.