The impact of Medicaid on research-based care in pediatric hematology/oncology

The dilemmas posed by Medicaid's inadequate reimbursement for health care are discussed. A short history of the intent of Medicaid is presented and Medicaid is contrasted with indigent care and care provided by health maintenance organizations or similar programs. Research care is expensive, and it is therefore often difficult to support Medicaid patients in research protocols. Current trends in research care delivery are summarized, and a potential solution is presented in which the support of the clinical research structure is transferred to support of the patient enrolled in a research protocol.