Decision Making Case Study

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Decision Making Case Study

Decision Making Case Study


This paper is based on a case study regarding decision making on Medicaid program. Every state's Medicaid program offers coverage for prescription drugs, but most have instituted cost-saving mechanisms, such as preferred drug lists, prior authorization, quantity limits on brand-name drugs, and mandatory use of generics (Thompson, 2008). Table 5.9 traces the growing use of cost-cutting measures in state Medicaid programs, based on data from the most recent edition of a survey commissioned by the Kaiser Commission on Medicaid and the Uninsured (KCMU).


Medicaid has experienced a very different fate. As health care moves closer to being viewed as a human right by the public, state governments have invested, albeit reluctantly, much larger portions of their state budgets into this program than they would have imagined when first adopted in the 1960s. As of 2002, nearly 20 percent of the average state budget pays Medicaid expenses, mainly to long-term care providers such as nursing homes. Part of Medicaid's enduring political support relies on medical providers being major beneficiaries of the program. Although the Medicaid program pays less than what private insurance does for a given procedure, the availability of a reliable pool of funds supports many medical providers who treat recipients of public assistance. Intense fiscal pressure on states from this program has led directly to adoption of managed care systems, at first cautiously permitted by Congress and later strongly encouraged in an effort to slow rising costs through the 2000s (Soss, 2007). On the whole, the Medicaid debate has taken a much less ideological tone than that surrounding welfare. Recipients cannot readily abuse Medicaid benefits, as contrasted to arguably poor choices they might make with cash or Food Stamps.

All of the 37 states that replied to the 2005 survey indicated ...
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