Longest (2010) emphasizes the cyclical nature of policy making. He asserts that there is a continuous feedback loop informing and shaping the policy. Those that initiated the policy and those affected by it will recommend some modification based on the outcomes. Positive outcomes should encourage further implementation of a policy and negative outcomes will demand a change.
This is clearly seen in the development of palliative care policies. SB 1004 in California was an outflow of the success of the AB 1745, or the pediatric palliative care waiver. AB 1745 was passed in 2009 and allowed for palliative and curative treatment to occur concurrently for children utilizing California’s Medicaid program (Keim-Malpass, 2013). This began as a pilot program entitled Partners For Children (PFC). According to a brief published by the UCLA Center for Health Policy Research outcomes from the PFC program included:
- A 32% reduction in the number of inpatient hospital days.
- An 11% reduction in total medical expenditure.
- An increase in families’ quality of life.
Building on this success, a similar provision was made in the Affordable Care Act (ACA), Section 2302.
Many challenges remain to the successful implementation of each of these policies. As we’ve learned through our dive into evidence based practice, sustainability depends on one’s ability to handle change. The same appears to be true with respect to policy making. Each of these policies, SB 1004, AB 1745 and Section 2302 of the ACA, requires continued action to be sustainable over time. Proponents of this legislation challenge policy makers and the public to support further research, training and access for palliative care.
- Further research is needed to enhance the scientific foundation of palliative care.
- Further training is needed to create a viable and sufficient workforce to meet the demand for services.
- Further action is necessary within the health care system to create payment models that support this care, expand community access to services and create quality metrics to define success.
The Affordable Care Act provides a living and breathing example on a grand scale. How the implementation of this legislation plays out may guide future policy development for years to come. The public is not convinced that health care reform is in their best interest. A Gallup poll in November of 2014 demonstrated a 37% approval rating for this legislation (McCarthy, 2014). We should expect a myriad of changes as the implementation of the ACA continues.
It appears that creating a favorable environment for the sustainability of palliative care policy is paramount. The evidence needs to not only be strengthened but to be translated in a meaningful way to the American public. Individuals must recognize that it is in their best interest to have access to these services should the need arise.
Center to Advance Palliative Care. (2011). A state-by-state report card on access to palliative care in our nation’s hospitals. Recommendations for action. Retrieved from http://reportcard.capc.org/recommendations#Research
Keim-Malpass, J., Hart, T. and Miller, J. (2013). Coverage of palliative and hospice care for pediatric patients with a life-limiting illness: A policy brief. Journal of Pediatric Health Care, 27(6), 511-516.
Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.
McCarthy, J. (2014). As new enrollment period starts, ACA approval at 37%. Retrieved from http://www.gallup.com/poll/179426/new-enrollment-period-starts-aca-approval.aspx