Bach M L, Oberg C N, Bryant N A, Boleman J L
Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis 55455.
J Health Care Poor Underserved. 1992 Spring;2(4):427-47. doi: 10.1353/hpu.2010.0356.
Recent proposals to reform Medicaid, driven primarily by the need for cost containment, rarely pay explicit attention to values. This paper presents the Medicaid Values Framework, the authors' interpretation of a set of societal ideals embodied in Title XIX of the Social Security Amendments of 1965. The Framework comprises seven interlocking values that are stratified into three interdependent tiers--access, quality, and equity. We use the access and equity tiers to analyze treatment of Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) recipients under Medicaid. We document striking inequities in eligibility standards and in funding for the two groups--inequities that unexpectedly fail to translate into marked disparities in access to Medicaid. In conclusion, we comment on why the present inequities exist and why they are ethically unacceptable.
近期主要出于成本控制需求而提出的医疗补助改革提议，很少明确关注价值观。本文介绍了医疗补助价值观框架，这是作者对1965年《社会保障修正案》第十九篇所体现的一系列社会理想的解读。该框架包含七个相互关联的价值观，这些价值观被分为三个相互依存的层次——可及性、质量和公平性。我们利用可及性和公平性层次来分析医疗补助计划下对有受抚养子女家庭援助（AFDC）和补充保障收入（SSI）领取者的待遇。我们记录了这两类人群在资格标准和资金方面存在的显著不公平现象——这些不公平现象出人意料地并未转化为获得医疗补助的明显差异。最后，我们对当前不公平现象存在的原因以及为何在伦理上不可接受进行了评论。
