Week Two- How do policy and ethics influence health?

How do policy and ethics influence health?

The Center to Advance Palliative Care (CAPC) (Morrison & Meier, 2011) has cited three overarching themes for public consideration with respect to advancing palliative care practice in the United States. These include:

  • Development of a specialized workforce.
  • Funding to create a strong research base.
  • Improved access to services.

Let’s look at access to services in California. CAPC has published the data related to availability of providers and services in a state by state report-card format. While many large (greater than 300 bed) hospital facilities report active participation in palliative care programs, small hospitals have not had the same success. Thus access to these services in a more rural community is poor.

State of California Report Card for Palliative Care Services

Retrieved from http://reportcard.capc.org/home/CA/RC/California/227 (24 January 2015)

The Standford School of Medicine (2015) reports that approximately 13% of the population in California reside in rural areas. The accounts for over 5 million individuals.  The assumption can be made that the majority of these individuals do not have access to palliative care services at their time of need.

Longest (2010) asserts that policy is the force behind many health determinants, this includes access to services. Public policy makes allowance for changes in the physical environment, reimbursement practices for hospitals and providers and funding for state and federal healthcare agencies. Access to services might also be limited in rural communities by the high cost of the care itself.

The American Medical Association (Levine et al., 2007) uses the term “equality of opportunity”. Do residents of rural areas have an equal opportunity to access quality care?

It is known that palliative care services provide a high quality- low cost service to individuals suffering from serious illness. Those individuals living in rural communities appear to be disadvantaged purely because of their place of residence. The question becomes ‘why is this valuable service unavailable in rural communities?’ Should these individuals have to leave their homes and families in a time of critical illness to seek better care? Is it ethical for individuals to ‘miss out’ on a valuable service because of where there home is located? Palliative care teams have successfully been implemented in approximately 80% of large hospitals in California (Morrison & Meier, 2011). These hospitals often have larger budgets for program implementation simply because of the volume of patients they service. Are additional funds needed to assist in the implementation of palliative services in the rural community? Should public policy be developed to ensure “equality of opportunity”?

Perhaps local, state and federal government could consider subsidizing the development of palliative care programs in rural areas. Considering the financial savings that might be afforded through long-term use of these services, the cost-to-benefit ratio is quite good.


Levine, M. A., Wynia,M. K., Schyve, P. M., Teagarden, J. R., Fleming, D. A., Donohue, S.K. … Emanuel, E. J. (2007) Improving access to health care: A consensus ethical framework to guide proposals for reform. Hastings Center Report, 37(5), 14-19.

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL:  Health Administration Press.

Morrison, R. S. and Meier, D. E. (2011). America’s care of serious illness: A state by state report card on      access to palliative care in our nation’s hospitals. Center to Advance Palliative Care. Retrieved    from http://reportcard.capc.org/

Standford School of Medicine, eCampus Rural Health. (2015). Rural California: Demographics. Retrieved    from http://ruralhealth.stanford.edu/health-pros/factsheets/index.html


2 thoughts on “Week Two- How do policy and ethics influence health?

  1. mcburkha says:

    You have very eloquently stated and identified an area of health-care lacking provision of services. A “sister” of palliative care, “hospice”, has successfully reached a rural population to provide end-of-life care. I propose that one avenue for consideration of addressing the rural need for palliative care services, would be to include this specialty within a home-health care format. I am very interested in following your evaluation of this topic and the policy process regarding forward movement toward providing palliative care to rural health care services.


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