Do ethics matter: Ethics goals and resource allocation in a community access to care program

Using a case study approach, this pilot project examined the relationship between the ethically-relevant goals and resource allocation decisions of a single paradigmatic Community Access Programs (CAP): an organization that provides access to health services for vulnerable uninsured individuals in their community. As part of the safety net, CAPs partake in the moral justification and goals of public health institutions, for example, social justice. The study found that ethically-relevant goals and values – such as the justice-related goal of providing access to healthcare to a population not otherwise receiving it in order to work toward a world in which all county residents will have the opportunity to live healthy lives – do ground the resource allocation decisions at the selected CAP. However, there are many additional goals and differences in priorities among the goals that administrators juggle when making resource allocation decisions. The history of rapid growth in the organization allowed administrators to obtain funds to both expand the number of enrollees eligible for minimal services as well as increase the depth, breadth, and quality of services received. However, the CAP priorities were highlighted when recession-related budget cuts forced tough funding choices, revealing that the CAP's fundamental commitment is to provide a minimum of primary care services to those individuals already enrolled in the program. Describing and improving the transparency of the existing decision-making process will allow for “quality improvement” in efforts to better align future policy decisions with ethical goals.