34 Medicaid enrollment after firearm injury increases likelihood of readmission among adolescents

In 2016, total Medicaid spending, $574.2 billion, represented one-third of state budgets. Descriptive studies indicate that state policymakers adjust social welfare programs during times of financial distress, particularly Medicaid. The challenge of formally estimating this effect is that macroeconomic shocks increase Medicaid enrollment and state-level financial stress. We use an exogenous measure of Medicaid generosity to estimate the elasticity of Medicaid generosity with respect to financial conditions. We find Medicaid generosity is not adjusted during periods of fiscal distress, whether anticipated or not. Instead, we find a counter-cyclical Medicaid effect with generosity increasing with increases in the unemployment rate.

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The “Rules of the Road”: Ethics, Firearms, and the Physician's “Lane”

The Journal of Law Medicine & Ethics ◽

10.1177/1073110520979415 ◽

2020 ◽

Vol 48 (S4) ◽

pp. 142-145

Author(s):

Blake N. Shultz ◽

Benjamin Tolchin ◽

Katherine L. Kraschel

Keyword(s):

Medical Ethics ◽

Patient Autonomy ◽

Critical Role ◽

Firearm Injury ◽

Agency Relationship ◽

The Road ◽

Firearm Violence ◽

Patient Agency ◽

Foundational Principle ◽

Do So

Physicians play a critical role in preventing and treating firearm injury, although the scope of that role remains contentious and lacks systematic definition. This piece aims to utilize the fundamental principles of medical ethics to present a framework for physician involvement in firearm violence. Physicians' agency relationship with their patients creates ethical obligations grounded on three principles of medical ethics — patient autonomy, beneficence, and nonmaleficence. Taken together, they suggest that physicians ought to engage in clinical screening and treatment related to firearm violence. The principle of beneficence also applies more generally, but more weakly, to relations between physicians and society, creating nonobligatory moral ideals. Balanced against physicians' primary obligations to patient agency relationships, general beneficence suggests that physicians may engage in public advocacy to address gun violence, although they are not ethically obligated to do so. A fourth foundational principle — justice — requires that clinicians attempt to ensure that the benefits and burdens of healthcare are distributed fairly.

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