In the spring of 1987, Arizona state government came face-to-face with a controversy partly of its own making and partly cause by national health policy in the United States. Regardless of the sources of the problem, however, it was the state government (the legislature primarily, but also the governor) who had to respond to public pressures over a state policy that rationed health care services in such a way that (a) Diana Brown (a 43 year old) died because the Arizona Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS) denied coverage for a transplant operation that was required for her survival, while (b) state-funded health care access for pregnant women and children aged six through 13 was extended to families with household income levels above that were higher than the AHCCCS qualification maximum but which were below the official federal poverty income level.
The public controversy centered on a woman's probable preventable death and assuring basic health services access to pregnant women and children in indigent households. The real policy issue (the big policy question), however, involve the appropriate use of state assets to fund health care services in Arizona.
The concept of social justice is highly relevant in this case. Social justice is a difficult concept to pin down, as many theorists tend to view the concept in different ways. For this writer, however, social justice is a combination of distributive justice, equity theory, and procedural justice. Distributive justice refers to the perceived fairness of outcomes. Equity theory suggests that people are sensitive to the relationship between reward and contribution for various members of a group or of a society. Procedural justice theory focuses on process ยท on the influence of decision-making procedures on the fairness of outcomes.
The issue of fairness is critical to the development of widespread public support for a health care p...