what’s best for the public health of montanans? an ethics-based framework for reconsidering...
Post on 14-Dec-2015
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What’s Best for the Public Health of Montanans?
An ethics-based framework for reconsidering Montana’s maternal child health home visiting program selection
and award process
“This initiative will give children a healthier start…” US Health Secretary Sebelius
• ACA provides $1.5 billion to states for home visiting services to maternal, infant, and child population.
III. Best Value for Public Funds?
• Every low birthweight baby or preterm birth costs states bewtween $28,000 and $40,000 in medical care costs.
• 6 - 10% of births will be premature and will account for 50% of Medicaid funds spent in infants
IV. Burdens on Citizens?
• Voluntary, but we must guard against stigma of targeting high risk folks.
• To the contrary, we can prevent and relieve health burdens suffered by vulnerable women, infants, and children.
• Save tax dollars for health care and social welfare costs.
Evidence of Program Effectiveness
• 79% reduction in abuse and neglect
• 35% less ER use• Higher vocabulary
skills at age 6• Higher reading and
math skills at age 9• 20% reduction in
welfare use
V. Is the Outcome Fair?
• Serve as many citizens as possible.
• Use the funds as intended and allocate it expediently.
• Allow for a variety of approaches.
• Involvement of local programs and citizens must be obtained.
Public Accountability
• What do we tell our citizens?
• What do we tell our legislators?
• What do we tell ourselves?
References
• Principles of the Ethical Practice of Public Health• Cook and Hoas, Ethical Decisionmaking Process• Montana DPHHS Final MIECHV Plan • Pew Charitable Trust, Issue Brief, May 2010• Nurse Family Partnership (www.nursefamilypartnership.org)
• Olds, David, “Effects of Nurse Home Visiting on Maternal and Child Funcioning: Age-4 Follow-up of a Randomized Trial” Pediatrics (online at
http://pediatrics.aappublications.org.content/120/4/e832.full)
• Gostin, Lawrence O., ed., Public Health Law & Ethics, Regents of the University of California, 2010
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