Arizona Health Care System Case Study

Arizona’s health care system is somewhat more complicated than that of other states. From 1972 to 1981, Arizona was the only state that had not accepted the federal Medicaid program. Instead, Arizona opted for their own system, where each county in the state was responsible for providing some measure of health care to the poor with their own money. The Arizona Health Care Cost Containment System (AHCCCS) was set up by the Health Care Financing Administration (HCFA) in 1981. AHCCCS was deemed to be “experimental” and was significantly different from the Medicaid system. Originally run by a private firm, the AHCCCS shifted control to the state starting in 1984. Dr. Donald R. Schallar was hired to head the program. By early 1987, 200,469

The reasoning is that there will always be cases that will require exceptions and making exceptions for those particular transplant cases would not be just or fair for other indigent people in need of transplants. So why not fund all transplants? That would not a principled decision for the state of Arizona based on their beliefs about healthcare, Medicaid, and governmental assistance programs. When looked at through the lens of this case, the deontological approach would be to cease funding for transplants. Dr. Schaller, a key player mentioned in this case, is closest to the deontological perspective. Not all of his views or actions align with this perspective, but his earlier views come the closest. “Right from the start, Schaller was uncomfortable about AHCCCS funding of transplants for several reasons. For one, he questioned whether a program with tight resources should be spending its money on high dollar, high risk procedures. After all, AHCCCS was intended as a general health program for the genuinely poor…[Schaller stated that the] AHCCS should provide ‘basic health care to poor people, not just cater to people who have real expensive health problems.” (Varley 1988, 318-319). Dr. Schaller’s ethical concerns eventually led to his attempts to deny transplant requests.

The options in the case included: fund all transplants, fund some transplants, or fund no transplants. Funding all transplants would be ideal for the people in need of transplants, but it would be extremely costly for Arizona’s health care system and government. Funding some transplants would be helpful for the individuals whose transplants are approved, but it would tragic for the rejected individuals. Additionally, the AHCCCS might face legal consequences as a result of some of the denials (as the organization had previously experienced). Not funding any transplants would be devastating for the people in need of transplants, it would be hard for the AHCCCS to stick to this policy without making exceptions, and exceptions would lead to more difficult decisions in the future. This case is complicated and there does not appear to be a clear/easy choice leading to a positive outcome overall. It is important to evaluate the ethical perspectives of a case in order to make an informed decision for the common