Ethics, Policy, and Finance in Healthcare

Medicaid Eligibility Fairness

Every state has its conditions for people who want to receive coverage under Medicaid. In Florida, these criteria are established by multiple entities: the Social Security Administration (SSA) and the Department of Children and Families (DCF) (“Florida Medicaid,” n.d.). DCF is the source of all regulations for such categories of people as children, their parents and caretakers, pregnant women, non-citizens, and aging or disabled persons. The SSA determines the rules of acquiring SSI (Supplemental Security Income) – a type of Medicate for low-income disabled and aged people. However, the two central regulations that apply to all mentioned above persons are citizenship or legal permission to reside in the US and low-income status.

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For instance, a pregnant woman may be eligible for Medicaid if she is a state’s citizen and the income of her family does not exceed the defined limit. The coverage for pregnant women is temporary and covers all pregnancy-related procedures. In Florida, the maximum income for a one-person family cannot exceed $16,040, and a $5,559 is added for each additional family member (“Florida Medicaid,” n.d.). As Sommers, Graves, Swartz, and Rosenbaum (2014) note, the described income cutoff may put some low-income families at risk of not being eligible. Moreover, people who do not qualify for additional subsidies are neglected by this program, thus making this coverage restrictive. The benefits of treating these people through Medicaid lie in their access to health care and following positive health outcomes. Income often has connections to one’s race, and people belonging to ethnic minorities may be assisted with additional financial aid (Piatak, 2015).

Using Hospital Compare

Two hospitals located in Florida are reviewed here – Aventura Hospital and Medical Center and Boca Raton Regional Hospital. The 30-day mortality rate in the first hospital is better than the national one, while the second hospital ranks similarly to the state average in most situations (“Medicare hospital comparison,” 2018). For example, the rate of stroke patients is the same for both organizations and the country, while the two hospitals have fewer deaths related to pneumonia than the average. As for the rate of readmissions, Aventura Hospital ranks worse than the national medium for unplanned visits after discharge. Boca Raton Regional Hospital presents data that is comparable with the state’s numbers.

These estimates can be used by both patients and healthcare professionals to determine the quality of care in a hospital. If the difference between the rates of the organization and the state is visible, the potential client may choose a hospital with better outcomes. A lower readmission rate can imply that the hospital provides patients with all necessary post-discharge information and contacts them after they leave the hospital. Moreover, death rates also show which conditions are handled better by the clinic. While the correlation between the numbers and the actual quality of care is not entirely transparent, some connection between these factors exists (Weeks, Kotzbauer, & Weinstein, 2016). This information can also influence the rate of admissions, and the overall perceptions of hospitals, encouraging them and their workers to develop new initiatives.

Health Care as a Right in the US

Currently, health care is not a fundamental right in the US. The concept of human rights lies in their universal accessibility – they should be available to every person regardless of his/her income, gender, race, and other aspects. In regards to health care, it can be seen that people’s financial situation, as well as healthcare knowledge, plays a significant role in their access to health care services. For example, low-income families and persons may not get access to these services because their income is not low enough. Furthermore, although the Affordable Care Act provides many people with opportunities to manage their health better than before, its strict regulations do not make all services equally affordable (Obama, 2016).

In its contemporary state, Medicare and Medicaid do not provide all communities with equalizing opportunities to make health care a fundamental right. Nurses’ ethical principles state that nursing professionals should advocate for underserved populations and treat all patients equally. Nonetheless, this concept cannot be fulfilled in an environment where people cannot be assisted because they do not have enough money for expensive procedures (Maruthappu, Ologunde, & Gunarajasingam, 2013). Thus, the division between ideological beliefs and reality exists in the healthcare sphere.

Distributive Justice in Health Care

The issue of justice and equity in health care is one of the most challenging ethical dilemmas. The notion that health care should be accessible to everyone lies at the basis of this problem. In the US, the main controversy related to equity is the fact that health care services are not free. On the contrary, most procedures and drugs are expensive, limiting the abilities of many people to receive adequate treatment (Cohn, Henderson, & Appelbaum, 2017). The existence of counties where pandemics change their national health outcomes for whole populations is another major concern that is often not addressed by other states. The issue of global and local distributive justice foregoes the ethical principle that health (both the absence of illnesses and the overall mental and physical well-being) is a basic human right (Cacari-Stone, Wallerstein, Garcia, & Minkler, 2014). Currently, some of these concerns are addressed by the Affordable Care Act which helps multiple groups to access medical services (Obama, 2016). However, the disparity between people with high and low incomes continues to exacerbate this dilemma.

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Cacari-Stone, L., Wallerstein, N., Garcia, A. P., & Minkler, M. (2014). The promise of community-based participatory research for health equity: A conceptual model for bridging evidence with policy. American Journal of Public Health, 104(9), 1615-1623.

Cohn, E. G., Henderson, G. E., & Appelbaum, P. S. (2017). Distributive justice, diversity, and inclusion in precision medicine: What will success look like? Genetics in Medicine, 19(2), 157-159.

Florida Medicaid. (n.d.). Web.

Maruthappu, M., Ologunde, R., & Gunarajasingam, A. (2013). Is health care a right? Health reforms in the USA and their impact on the concept of care. Annals of Medicine and Surgery, 2(1), 15-17.

Medicare hospital comparison. (2018). Web.

Obama, B. (2016). The United States health care reform: Progress to date and next steps. JAMA, 316(5), 525-532.

Piatak, J. S. (2015). Understanding the implementation of Medicaid and Medicare: Social construction and historical context. Administration & Society, 49(8), 1-26.

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Sommers, B. D., Graves, J. A., Swartz, K., & Rosenbaum, S. (2014). Medicaid and Marketplace eligibility changes will occur often in all states; policy options can ease the impact. Health Affairs, 33(4), 700-707.

Weeks, W. B., Kotzbauer, G. R., & Weinstein, J. N. (2016). Using publicly available data to construct a transparent measure of health care value: A method and initial results. The Milbank Quarterly, 94(2), 314-333.

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