Policy and Advocacy for Improving Population Health

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February 1, 2019
Community Health Nurse: The Elderly
February 1, 2019

Policy and Advocacy for Improving Population Health

Resource Allocation for an Aging Population

Technological advances in medicine and preventative care means that Americans are living longer lives than ever before. Hayutin, Deitz, and Mitchell (2010) assert that by the year 2030 Americans over the age of 65 will account for 20% of the population. There will soon be more elderly Americans than children, and the number of working adults is expected to decrease concurrently. This shift in the population will yield significant economic, political and social challenges. Healthcare needs are also changing. Death and disability rates are declining, yet the incidence of chronic illness within the elderly population continues to rise (Hayutin, Deitz, & Mitchell, 2010).  Crippen and Barnato (2011) contend that 20% of the population assume 80% of all healthcare-related costs. As much as 75% of these costs are attributable to chronic diseases (Crippen & Barnato, 2011). Revenues for healthcare are projected to decrease while expenditures are expected to increase. Healthcare providers, policymakers, and industry experts need to work towards solutions that will optimize healthcare dollars and create sustainability for future generations.

Ethical Considerations

The dynamics of healthcare are complicated; financial resources seem insignificant when making life and death decisions. Nonetheless, resources are finite, and therefore, distribution and allocation of funds must be ethical. According to Craig (2010), the theory of distributive justice requires that people with the same health needs have equitable access to all available resources. However, distributive justice also requires that the associated costs also be shared equitably. Fairness is another ethical principle that should be applied in the allocation of healthcare resources. Policies that are fair must be transparent, understandable, and there must be regulatory process to address complaints and resolve conflicts. The idea that healthcare is a human right is outlined in the declaration of independence which guarantees citizens the right to life, liberty, and the pursuit of happiness. The need of the patient should also be considered. A burn patient needs plastic surgery more than a patient that wants rhinoplasty (Craig, 2010).

Nurses provide the best possible care to every single patient regardless of gender, ethnicity, sexual orientation, ability to pay, or age. The American Nurses Association (2012) provides ethical guidelines for nurses to employ in their practice. Provisions one, two, and three promote the principle of beneficence, and the obligation nurses have to advocate for the best interests of their patients. Provisions seven, eight, and nine focus on providing social justice for clients through practice and policy (American Nurses Association, 2012). Nurses should also promote autonomy, an ethical principle that focuses on the patients right to make their own decisions regarding their care. Finally, the principle of non-maleficence means that the nurse must not harm.

Ethical Dilemma

Healthcare resources are often viewed as an investment. The sicker the patient, the more risk is associated with allocating recourses for their care. Systematic health care rationing is effective for resource conservation and allocation. In Great Brittan, an elderly patient would not be an unlikely candidate for an organ transplant because the rate of complication and death are significantly increased for this population. Healthcare dollars are reserved for patients that will have the most benefit and are likely to have the best outcomes (Craig, 2010).

However, this type of resource allocation is unethical. The ethical principles of distributive justice, autonomy, beneficence, non-maleficence, fairness, need, and healthcare as a human right must be upheld for each patient. Even though it is necessary to provide ethical care, our current path is financially unsustainable. We are consuming healthcare resources more quickly than we are earning revenue. The cost of chronic disease is our biggest expenditure. Our children will be paying not only for us but for the care consumed by their grandparents and great-grandparents. It is not unethical for young workers to finance care for the elderly, but rather, is implicative of the high costs associated with healthcare (Crippen & Barnato, 2016).

Solutions

Healthcare costs must be controlled, or revenues must be increased to provide all patients with equitable care. I believe the most logical strategy is to control costs through health promotion. Healthcare policies should incentivize healthy choices and preventative care. Research indicates that patients with mental illness have the highest rates of chronic disease. It seems counterintuitive to spend money to save money. Nonetheless, financial investments in mental healthcare will decrease the amount of money spent on chronic illness (Crippen & Barnato, 2016).

Policy changes are necessary to ensure fair and ethical distribution of healthcare resources. Making changes that focus on prevention and health promotion will help younger generations. However, we must also make adjustments that will control costs for those who are already chronically ill. Karnik & Kanekar (2016) assert that healthcare providers should encourage patients and their families to engage in end of life planning strategies. It is essential to do this before a patient is too ill to make decisions for themselves. Healthcare organizations should institute standards for end of life and palliative care. Polices should also promote a regulatory process to resolve conflicts such as an ethics board (Karnik & Kanekar, 2016).

People do not like to talk about end of life care; it is unpleasant. There are also a lot of misconceptions about what can realistically be done to save a person who is dying. Providers need to do a better job at explaining what heroic measures constitute – broken ribs, sedation, ventilation, pain, complications, infections, and the significant emotional and financial cost associated with such. Additionally, advanced directives are frequently limited to the state in which a person resides. Should a person become medically incapacitated in a different state there is a very small chance that anyone will know about an advanced directive until it is too late. I would propose a policy that list basic advanced directive information on state issued identification. Organ donation status is already identified on state issued identification, so adding advanced directive information seems like a logical measure. Moreover, a national database that lists advanced directives would be extremely helpful. If such a service were voluntary, and required consent, it would theoretically comply with HIPPA regulations. Moreover, these measures would ensure patient autonomy and would alleviate the next of kin from making extremely difficult life and death decisions for the people that they love.

References

American Nurses Association. (2012). Code of Ethics for Nurses. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

Crippen, D., & Barnato, A. E. (2011). The ethical implications of health spending: Death and other expensive conditions. The Journal of Law, Medicine & Ethics,39(2), 121-129. doi:10.1111/j.1748-720x.2011.00582.x

Hayutin, A. M., Deitz, M., & Mitchell, L. (2010). New realities of an older America. Retrieved from http://www.nasuad.org/sites.nasuad/files/hcbs/files.199/9941/New_Realitites_of_an_Older_America.pdf

Karnik, S., & Kanekar, A. (2016). Ethical issues surrounding end-of-life care: A narrative review. Healthcare,4(2), 24. doi:10.3390/healthcare4020024