Healthcare policy is a result of critical analysis, decision making, and planning that influences societal actions and behaviors in order to reach ideal health goals. These policies may be implemented at the federal, state, or local levels and impact individuals or organizations in various ways (Longest, 2019). Governments are designed to serve the best interest of its people. However, when it comes to healthcare the current policies in place do not always support optimal health. Have you ever wondered why that is? How does the government determine regulations in providing health care?
While there may be not be a definitive answer, one may deduce that the role of ethics is an important part in government decisions regarding health. However, policy formation may be influenced by agendas, actions, or ideas which matter most to agency officials and are more likely to gain traction with large interest group support (Switzer, 1994). When it comes to healthcare reform, prioritization of policy formation should avoid opinion of importance. Healthcare policies should be guided by five principle ethical values: universal access, equity, cost, quality, and choice (Gostin, 2017). Medicaid dental coverage for pregnant women is unfortunately inconsistent of these ethical values.
Ethical Values in Healthcare Policy Decisions: Universal access, equity, cost, quality, and choice.
Equity: Dental health providers may turn away their services from pregnant women until after pregnancy. According to a national survey, 77% of obstetricians and gynecologists reported that their patient was denied dental care because of their current pregnancy (CDHP, 2018).
Costs: Medicaid dental benefits are considered optional among states. These benefits for pregnant women rely on the contingency of available funding and is likely to be discontinued if budgets do not permit (CDHP, 2018).
Quality: The extent of dental coverage differs from state to state and only 18 states provide comprehensive dental benefits that include preventive and restorative services (CDHP, 2018). Additionally, Medicaid coverage may be time sensitive because it only extends 30 to 60 days post-partum and there is a small eligibility window to enroll.
Choice: Pregnant women are at a disadvantage in making autonomous choices regarding their dental health because limited options for this service exist under Medicaid. Additionally, eligible providers may even decline their services until the postpartum period thereby limiting choices and access for pregnant women.
These values of universal access, equity, costs, quality, and choice are important ethical values to consider when forming healthcare policies. This is especially important for pregnant women because of their vulnerable population status.
Consider: Unintended Pregnancy Rates
Unintended pregnancies account for 45% of all pregnancies in the U.S. (Guttmacher Institute, 2020). Women living in poverty and of low socioeconomic status are significantly affected by unintended pregnancies and are likely to encounter socioeconomic barriers in receiving comprehensive dental coverage. Incorporating values of universal access, equity, costs, quality, and choice will help alleviate social determinants of health barriers that many pregnant women face.
It is time for healthcare policies to place more emphasis on individual and population well being and produce actions with the greatest amount of good and least amount of harm as a reflection of ethical decision making and principle values.
References:
American Pregnancy Association. (2019). Medicaid for pregnant women. Retrieved from https://americanpregnancy.org/first-year-of-life/medicaid-for-pregnant-women/
Children’s Dental Health Project. (2018, September). Oral health in pregnancy (Issue Brief No. 339). Retrieved from https://www.cdhp.org/resources/339-issue-brief-oral-health-during-pregnancy
Gostin, L. O. (2017). Fie ethical values to guide health system reform. Journal of American Medical Association, 318(2), 2171-2172. doi:10.1001/jama.2017.18804
Guttmacher Institute. (2020). United States pregnancy: Unintended pregnancy. Retrieved from https://www.guttmacher.org/united-states/pregnancy/unintended-pregnancy
Longest, B.B. Jr. (2010). Health policymaking in the United States. (5th ed.). Chicago, IL: Health Administration Press.
Switzer, J. V. (1994). Disabled policymaking/disabled policy. In Disabled rights: American disability policy and the fight for equality (pp.12-29). Washington DC: Georgetown University Press.
Texas McCombs. [McCombs School of Business]. (2018, December). Ethics defined: Ethics [Video file]. Retrieved from https://www.youtube.com/watch?v=4vWXpzlL7Mo.
Oral Health Care Screening in Pregnancy 
I appreciated your discussion and contribution on ethical considerations, barriers and access to dental care during pregnancy through Medicaid programs. While my topic for this course is on Dental Coverage and Medicare for our older adults, we share many similarities when it comes to at risk populations and overall preventative health needs present. After reading your post I did a little digging as was surprised, but made complete sense after the fact, of just why this is so necessary during pregnancy. The increased risk of tooth decay, gingivitis, and pregnancy “tumors” during pregnancy coupled with the self-health neglect many unintentionally do post-partum (American Dental Association, n.d.) is a worthwhile case. While researching my topic I have also uncovered material on our Medicaid system but as you stated, as each state may chose how and what “other” services they will include, it makes your particular interest very difficult looking at it from a federal level. I am very interested to follow up on where Arizona falls on this initiative. Particularly knowing how many pregnancies are unintentional and those that qualify for Medicaid due to this are not likely thinking of their oral health needs during this time.
Our readings this week and last reinforced why many stay clear of politics. It is difficult to know the right thing to do AND actually do the right thing for some when it comes to politics. You reinforced this when you noted how the interests of one party may not coincide with the interest of the greater good. This makes it that much harder to stomach when we know how important oral health is for any population group. Longest (2010) noted that anyone involved in healthcare, including recipients, are considered “demanders of health policies” (p.37). Yet most of these demanders are not educated on political literature and agenda setting. It is often difficult to get public involved in a cause, particularly your chosen population because the priority for them is pregnancy, labor and managing new responsibilities. This paves the way for larger interest groups with better financial ties and backing to get their agenda front and center. This ethical wall is what continues to maintain the status quo.
With State and Federal entities providing a healthy portion of health coverage and influencing most of our political healthcare agenda, it is up to the public to advocate for and make our needs known (Longest, 2010).
Longest, B.B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press
Mouth Healthy. (n.d.). Is it safe to go to the dentist during pregnancy. American Dental Association. https://www.mouthhealthy.org/en/pregnancy/concerns
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I have enjoyed continuing to read about your topic and see how you began to address this issue with consideration to the ethical principles. I found the five you addressed to be intertwined with the four philosophical principles of respect for persons, justice, beneficence, and maleficence. The American Dental Association has their own “Principles of Ethics and Code of Professional Conduct” that directly addresses ethical dilemmas and how they align with these ethical principles (Raimann, 2016). Addressing the ethical principle of choice or autonomy is recognizing individuals have the right to make decisions and choices about their treatment (Longest, 2016). Dentists have the responsibility to inform the patient of treatment in a way that allows the patient to be involved in care. If the dentists are refusing to treat pregnant patients, they are not even engaging with the patient to understand her needs. This prevention of shared decision making creates an ethical break (Raimann, 2016). The principle of nonmaleficence is an obligation to not cause harm (Longest, 2016). There is a potential of harm by a dentist refusing to treat a patient (Raimann, 2016). As you have mentioned, oral health care is beneficial for both the mother and the fetus and there is a risk of multiple dental health issues if a mother does not receive proper care during pregnancy. Justice, or equity, addresses that people should be treated fairly (Longest, 2016; Raimann, 2016). Simply put, refusing to treat a woman because she is pregnant is discriminating against her unjustly, directly going against this principle (Raimann, 2016).
References
Longest, B. B., Jr. (2016). Health policymaking in the United States. Chicago, IL: Health Administration Press.
Raimann, T. (2016). The ethics of dental treatment during pregnancy. The Journal of the American Dental Association, 147(8), 688-698.
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