Health Policy - Research Paper Example

?Running head: HEALTH POLICY Health Policy (school) Health Policy I. Introduction The health policy bill to be discussed in this paper is the A1968 Needs Allowance for the Elderly Residing in Nursing Facilities. This was first introduced in the New Jersey legislature in February 8, 2010 and was sponsored and supported by assemblyman Jack Conners and Herb Conaway; it was also co-sponsored by Patrick Diegnan, Jr. Due to their advancing age, the elderly often encounter various chronic health issues (Katlic, 2011). For which reason, they often require continuous care and constant supervision. Health-wise, they are sometimes best left in health facilities or assisted living facilities where they can have constant supervision and available medical care (Katlic, 2011). The elderly with dementia needs continuous supervision because they may sometimes put themselves and others at risk. Many of the elderly facilities however do not have the adequate resources to ensure the delivery of adequate health services and to ensure the delivery of health needs. However, with the current global economic crisis, budget cuts have been implemented in the health care sector, especially for the elderly care budget (Luhby, 2011). With these budget cuts, deficiencies in the expenses for the elderly have been seen. As a result, a significant number of needs and allocations for the elderly have been reduced. The elderly patients with dementia, just like other elderly patients, need personal needs, and these personal needs are often not covered by the state budget. And yet, the states cannot cover most of these expenses due to other dire and significant needs which need to be filled. This paper shall now discuss the policy, including the advantages and disadvantages of this policy and in relation to its application among dementia patients. Both sides of this issue shall be tackled, more particularly on concerns which relate to health disparities and cost effectiveness policies as well as arguments in relation to decision-making policies. II. Description of the proposed bill/policy This policy is meant to increase monthly personal needs allowance of about 35,000 individuals currently living in nursing homes, state hospitals, and state development centers from $35 to $50. This allowance is meant to be used by these individuals for their personal needs, including clothing, grooming aids, newspapers, and similar items which are not normally provided by the facility (e-Lobbyist, 2010). For those receiving SSI public assistance, the bill also directs the Commissioner of Human Services to manage the increase in PNA if the federal authorities are unable to do so. Moreover, the commissioner is also tasked with guaranteeing that the increase in the PNA is not included in the income for the SSI beneficiary and is deducted from the federal payment (e-Lobbyist, 2011). This policy emphasizes that individuals who are qualified for medical assistance and other health services under P.L.1968, c.413 and who are already receiving medical help under (4) (a) subsection a or under paragraph (11), (13), (14) of subsection b of section 6 of P.L. 1968, c. 413 and is not qualified for Supplemental Security Income benefits based on 42 USC 1382 (e) (1) (B) (eLobbyist, 2011). These provisions also establish that the commissions would make agreements with the government to ensure the implementation of supplementary payments by the government for a time and based on conditions as the commissioner would set based on his appropriate discretion. This bill also establishes and amends the rules and regulations necessary to implement the terms of the government for the administration of the supplementary payments; to guarantee social services for eligible individuals and other aged, blind, and disabled individuals as designated by the commissioner (eLobbyist, 2011). This policy also emphasizes that the commissioner would pay the government the funds which are needed to reimburse the government for expenses in collecting additional information needed for the state to establish eligibility determinations for medical assistance under the "New Jersey Medical Assistance and Health Services Act” (eLobbyist, 2011). The commissioner must also require welfare boards to carry out eligibility assessments as deemed necessary by the commissioner for the support of the New Jersey Medical Assistance Program. He must also carry out the much needed actions to ensure maximum federal financial participation in supporting assistance to qualified individuals living in residential health facilities (eLollbyist, 2011). It is also the commissioner’s task to make sure that all eligible individuals living in a rooming or boarding house has monthly allowances already reserved. This personal allowance may also vary based on the kind of facility where the eligible individual is residing, but it shall not be less than $50 per month. These eligible individuals are also qualified to receive medical assistance of $25 a month aside from their other benefits (eLobbyist, 2011). In instances when the government cannot implement a $10 monthly increase, the commissions must carry out this increase and ensure that this increase is not income for supplemental security income program purposes. This commissioner is also tasked with evaluating welfare boards at the beginning of the fiscal year in order to ensure that the amount of each county’s share is based on the number of eligible individuals in the county (eLobbyist, 2011). This act is set to take effect on the first day of the third month after its enactment, except for section 2 of this act which shall be implemented until the federal government secures the commissioner’s administrative plans. This policy is currently with the Assembly Human Services Committee for appropriate evaluation. Further evaluations for this policy shall be carried out by the committee and shall be returned to the legislature for appropriate evaluation – enactment or the opposite (eLobbyist, 2011). The appropriate assessment shall be based on the merits of the law and the availability of government support for its policies and provisions. This assessment shall also determine possible revisions to the policy based on recommendations of the committee and other concerned government officials. III. Discussion/arguments to date -- Proponents of Proposed Bill Arguments for the passage of the bill mostly revolve around the need to provide health services for the vulnerable individuals in society (Rand Corporation, 2010). The elderly individuals are vulnerable because their health and immune systems are often compromised, making them vulnerable to diseases and the repeated occurrence of these diseases (Rand Corporation, 2010). They are also vulnerable to chronic illnesses and muskulo-skeletal diseases which often make them vulnerable to falls and which compromises their mobility. These elderly members of society are also likely to have limited access to social services, including housing and shelter (Barrett, et.al., 2010). As a result, it is important for the government to step in and assist in order to ensure that these elderly members of society receive adequate health services within their nursing home units. These personal allowances pay for needs which are not usually covered by other allocations. And yet, the needs which these personal allocations cover are still essential needs which are meant to cover clothing, grooming aids, and newspapers (Barrett, et.al., 2010). These needs help to improve the quality of life of elderly residents; moreover, they impact on the emotional and mental well-being of patients. As was mentioned previously, this bill was introduced by assemblyman Jack Conners and Herb Conaway, and was co-sponsored by Patrick Diegnan, Jr. Their advocacy of this bill highlights the fact that elderly individuals in nursing homes rarely have any disposable income (Stadnyk, 2010). Over the years, efforts have been solidly made in an effort to increase the personal needs allowance of these residents because of the understanding of the fact that the quality of life of residents can be significantly improved if residents are also able to afford other activities and other needs in the nursing home setting (Lamster, et.al., 2008). In other states in the US, efforts have been made since the 1990s to increase needs allowances for the elderly patients in nursing homes; however, due to the negative political environment, these efforts have been difficult to implement (Lamster, et.al., 2008). For these elderly citizens, some of them are actually independent enough to carry out their own activities; as such, they are able to participate in their grooming, their shopping, and other leisure activities. They need more money to carry out these activities and to continue to live independent lives. Among patients with dementia, their needs allowances would also help achieve a similar purpose – improving on the quality of their lives and helping them retain many of their independent functions with minimal supervision (Inouye, et.al., 2009). Among the elderly population, investing on measures to improve the quality of their lives are important investments and allocations because they are meant to reduce the deterioration of their physical and mental health . In effect, these allowances would make them less vulnerable to chronic and other diseases, as well as mental and emotional set-backs including depression and anxiety (Inouye, et.al., 2009). On the other hand, support for this bill is not logical and viable in the current age of economic crisis and difficulties. In applying one of the better economic concepts of rationalization, increasing needs allowances for the elderly is not a rational decision. This would mean redirecting and reallocating already limited resources to benefit a population which is not contributing to the economy. In terms of returns in investments, allocations for the elderly are not very profitable (Shi and Singh, 2011). It is therefore not prudent and effective economic practice to increase and allocate needs allowances for the elderly. There is a need to rationally allocate limited resources in the health care practice because rational allocations can help improve the delivery of health services (Shi and Singh, 2011). Improved allocations in health care spending can also help achieve better investments – especially for the younger adult population who can potentially rejoin society as productive members. It is therefore more rational for the current allocations in needs allowances to remain at $30 because the state cannot afford to increase such allocations without causing some other more rational allocations to be downgraded or to be deprived of allocations. The meaning of old age impacts significantly on the allocation of resources. This meaning would also be assisted by the understanding of medicine on the role and possibilities for the elderly (Shi and Singh, 2011). However, for the most part, the medical practice has often been ambivalent about aging and the death which often follows. And this ambivalence, has translated to its inability to separate disease and illness and eventually, death. The goal of medicine has always been on eliminating diseases and other harmful conditions related with aging and addressing diseases which cause death (Shi and Singh, 2011). For the most part, this has been successful and many people have been able to live long lives, staying active and able to take care of themselves. However, such success, and the hopes for more success has come at a price. It has also caused much bias in various health systems towards these forms of medicine, including acute care medicine which mostly aims to cure disease and delay death (Shi and Singh, 2011). The strength of contemporary medicine has now been based on the search for medical cures and the use of improved technology and acute-care services in order to extend life. Limited resources and little research have now been allocated towards improving and stabilizing the lives of those who cannot anymore be assisted by high-technology medicine (Shi and Singh, 2011). A traditional aspect of medical ethics – caring for those who cannot anymore be cured is often forgotten, and often depleted in resources which are needed to ensure efficacious in the lives of the elderly citizens in the nursing home settings (Shi and Singh, 2011). Based on various studies, the impact of limited resources in the current economic crisis has largely impacted on the elderly and other vulnerable members of society, including the disabled, and the mentally ill, including the elderly citizens suffering with dementia (WHO, 2008). On the other hand, in considering the best and most rational way of allocating limited resources, it is best to allocate limited resources to those which are needed most and which would serve the best purposes for the delivery of health resources. For example, choosing to allocate funds for researches on childhood diseases is a much more rational expense as compared to allocations for the elderly. The overall implications may be harsh and often unmerciful towards the elderly, however, the basis of health economics is rationalization and in order to make effective decisions of care, the harsh and often unpopular decisions must be made (Shi and Singh, 2011). IV. Impact of health status, access to care, health disparities, and cost effectiveness Health status has a significant impact on this policy issue because those whose health status is low would have greater needs and their health allowances would sometimes not be sufficient to fill in these needs (Bandari, 2008). On the other hand, those whose health status is high or relatively healthy would most likely not be able to benefit much from these needs allowances. In terms of access to care, not all elderly citizens are admitted to nursing homes or similar covered health centers of facilities. Since they would not be within the nursing homes, they would not be covered by the needs allowances (Goldberg, 2010). Their lack of access to these needs allowances may therefore result to a decreased quality in their lives. The needs allowances allow for simple commodities which are nevertheless important in ensuring quality health services. In relation to cost-effectiveness, the increase in needs allowances may be deemed as not cost effective because they increase the burden on an already strained health financing system. Cost effectiveness is based on the efficient allocation of health services, and efficiency is supported by the health rationalization approach which seeks to justify every expense in terms of the beneficiaries and the return of investments (Goldberg, 2010). Increasing allocations for the elderly is not considered rational because there are other expenses in the health care service which need to be prioritized. Elderly allocations are also low in terms of returns in investments because most of the elderly citizens are no longer working or are retired from their work. There is a strong basis for age bias against the elderly citizens, however, in the current context of financial and health financing crisis, the needs of the elderly citizens cannot take precedence over and above the needs of the younger and currently or potentially more productive citizenry (Goldberg, 2010). The health policy addresses the above issues by allowing those who have limited access to health services and needs allowances to increase their allowances and have the opportunity to improve the quality of their lives in the nursing homes. Among those with dementia, increased needs allowances would help provide clothing allowances, as well as higher resources for grooming within the nursing homes and care facilities. These resources would not make a significant impact on the treatment of their disease, but it would make a significant impact on their overall physical and emotional well-being (Goldberg, 2011). These needs allowances would also help prevent the further deterioration of their health, preventing the worsening of their dementia and memory gaps. The personal needs allowances also address the issues of access to care. Many of the elderly citizens have reduced access to care because of limited resources. This new bill would seek to provide them improved access to health resources, resources which they would not normally gain through the usual channels in health care (Goldberg, 2011). This health policy is important in terms of providing an equalizer for the vulnerable population, in this case, the elderly who is often subjected to age bias in terms of health finance allocations. Cost effectiveness is also addressed in this policy because it provides rationale and support for these allocations. Details on these rationalizations are however limited and are not convincing (Goldberg, 2010). More details and specific rationalizations need to be established before an effective allocation can be established for this health policy. Cost effectiveness can be seen in this bill in terms of the specific inclusive indications for the term personal needs allowances. V. Recommendations Based on the above discussion, there are various recommendations which can be made for this policy. First and foremost, it is important for legislators to review its provisions and establish a more thorough and clear rationalization for such provisions. Secondly, changes in the provisions must also consider adjustments in the amount of increase. The increase may be at a lower rate in order to be less burdensome to the health budget. Such lower rate of increase would also be easier to justify and later, easier to approve into a law. Thirdly, set allocations may be established for each age group. This would help equalize the pattern of allocation for all citizens regardless of their age group. Finally, increased investments in health and less on other societal needs can help ensure that these personal needs allowances would be covered by the governmental budgets. VI. Summary/Conclusion The above discussion establishes that the policy bill which would seek to increase the needs allowances for elderly citizens from $35 to $50 dollars is a highly beneficial policy for the elderly because it would seek to improve the quality of their lives. This increase in allocation would also help improve the coping mechanisms of these elderly citizens. Some elderly citizens find it hard to live quality lives due to their chronic illnesses and limited income; this needs allocation would help secure their essential needs. However, seeking the passage of this policy would be difficult because of the current economic crisis. This crisis has forced the government to practice more prudent and rationalized allocations for its limited resources. It is therefore important for the government to make adjustments on this policy in order to make it more rationalized and detailed. There are essential services and benefits which this policy can potentially bring to the elderly citizens, however, some adjustments have to be made on these policies in order to ensure their passage and applicability in the practical and clinical setting. Reference Allen, M. (2010). Transforming Housing for People with Psychiatric Disabilities. New York: DIANE Publishing. Barrett, A., Schimmel, J., & Mathematica Policy Research. (2010). OAA Title III Services Target the Most Vulnerable Elderly in the United States. Administration on Aging. Retrieved 03 November 2011 from http://www.mathematica-mpr.com/publications/PDFs/health/vulnerableseniors_IB2.pdf Bhandari, S. (2008). Health Status, Health Insurance, and Health Services Utilization: 2001: Household Economic Studies. New York: DIANE Publishing. eLobbyist (2010). Assembly no. 1968, State of New Jersey 214th Legislature. Retrieved 03 November 2011 from http://e-lobbyist.com/gaits/text/46214 Katlic, M. (2011). Cardiothoracic Surgery in the Elderly: Evidence-Based Practice. New York: Springer. Goldberg, G. (2010). Poor women in rich countries: the feminization of poverty over the life course. New York: Oxford University Press. Luhby, T. (2011). States kick grandma to the curb. CNN.com. Retrieved 03 November 2011 from http://money.cnn.com/2011/03/14/news/economy/senior_citizens_elderly_state_budget_cuts/index.htm Lamster, I., Northridge, M., & Takamura, J. (2008). Improving oral health for the elderly: an interdisciplinary approach. New York: Springer. Inouye, K., Pedrazzini, E., Pavarini, S., & Yoshie, C. (2009). Perceived quality of life of elderly patients with dementia and family caregivers: evaluation and correlation. Rev. Latino-Am. Enfermagem, 17(2). Rand Corporation. (2010). Developing Quality of Care Indicators for the Vulnerable Elderly. Retrieved 03 November 2011 from http://www.rand.org/pubs/research_briefs/RB4545-1/index1.html Shi, L. & Singh, D. (2011). The Nation's Health. New York: Jones & Bartlett Learning. Standyk, R. (2009). Three Policy Issues in Deciding the Cost of Nursing Home Care: Provincial Differences and How They Influence Elderly Couples' Experiences. Health Policy, 5(1): e132–e144. World Health Organization. (2008). Impact of the global financial and economic crisis on health. Retrieved 03 November 2011 from http://www.who.int/mediacentre/news/statements/2008/s12/en/index.html Read More