243348 Do ethics matter: Ethics goals and resource allocation in a community access to care program

Monday, October 31, 2011

Krista Harrison, PhD Candidate , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Ligia Paina, PhD Student , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Washington, DC
JP Leider, PhD Candidate , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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.

Learning Areas:
Administer health education strategies, interventions and programs
Ethics, professional and legal requirements
Program planning
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1. Define a community access program and its role in the safety net. 2. Describe the ethics goals and resource allocation decisions at a paradigmatic community access program 3. Assess the relationship between goals and resource allocation decisions

Keywords: Ethics, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student of bioethics, health policy, and public health, trained in qualitative and quantitative methods.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Issues in Public Health Ethics
See more of: Ethics SPIG