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Introduction
Health care often focuses on the treatment of patients with acute conditions, while little attention is paid to the management of chronic diseases. Patients with chronic conditions may experience inequities in quality of care without adequate long-term therapy. The gap in the quality of care affects patients with chronic diseases the most, as they can receive necessary treatment when their condition worsens or severe complications occur. Additionally, there is often a significant gap between recommended evidence-based treatment for diagnosed chronic disease and actual practice. The provision of quality long-term care for patients with chronic diseases can significantly increase their life expectancy and improve its quality, although not cure the disease entirely.
Discussion
The identified gap is not an exclusively modern problem, as patients with chronic diseases have existed throughout the history of healthcare development. However, the scale of this issue in the modern world is growing much faster than before. About half of all adults in the US suffer from at least one chronic disease, and the numbers continue to rise, according to researchers (Raghupathi1 & Raghupathi, 2018, p. 1).
Boersma et al. (2020) report that around 25% of adult Americans have multiple chronic conditions, including arthritis, cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease, current asthma, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys (1,2) (p. 1). Additionally, the gradual increase in the number of chronic diseases among children suggests a proportional increase in the number of adults with chronic conditions in the future (Raghupathi1 & Raghupathi, 2018). Thus, several factors including the general aging of the population and the increase in chronic diseases among young and middle-aged people contribute to the problem.
Chronic disease management is associated with increased healthcare costs, so people with lower incomes are more likely to have difficulty accessing care. Additionally, disease prevention measures are more expensive. People with low income often do not have access to adequate methods for diagnosing diseases at an early stage and preventing the development of chronic diseases (Reynolds et al., 2018).
The healthcare delivered to the population is greatly affected by the gap in access as people from low-income socioeconomic backgrounds do not have options for appropriate treatment options. This leads to the occurrence of severe complications, lower quality of life, and higher mortality risk. If the gap in quality of care for people with chronic diseases is not addressed, the potential implications could be an increase in mortality rates from chronic diseases, as well as an increase in medical expenses and productivity losses.
Existing Initiative
Currently, there are several initiatives in the US that target the needs of patients with chronic diseases. One of them is the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), which funds and guides programs to develop better chronic disease prevention and management interventions throughout the United States (National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), n.d). The specific goals of this initiative are to identify risk factors for chronic disease, improve the environment to promote healthier choices and improve healthcare systems to provide better preventive care for vulnerable groups.
NCCDPHP was established in 1989 and was one of the first major chronic disease prevention programs in the United States. The circumstances around the development of the existing initiative included a steady rise in the number of chronically ill patients in the US in the late 20th century, including children (Collins et al., 2009). At the same time, the costs of managing chronic diseases within the healthcare system also continued to grow, which required a new approach to addressing the problem. Factors such as existing risk factors for chronic disease development and effective prevention interventions have been considered in developing the program.
Funding for the initiative comes from the federal budget, which limits the scope of the program. Its funding requires extensive financial resources in various areas of research and development of initiatives to prevent chronic conditions. Although the initiatives implemented by the program help prevent the development of serious complications in some patients with chronic diseases, they do not target the most vulnerable populations. The program is not meeting its goals because it affects in most cases people who already have access to medical care for the management of conditions. The program could be improved if it included special interventions to help people from the most vulnerable groups, including people with low incomes.
Regulation
The most significant regulation that currently exists in the US regarding the identified gap is the Affordable Care Act (ACA). This legislation was passed in 2010 by Barack Obama (Daaleman & Helton, 2018). This program focuses on disease prevention, which also includes significant reform of the US healthcare system to expand access to healthcare. As part of this legislation, many states significantly expanded the Medicaid program, which provided insurance to a large part of the population. However, many low-income people faced disparities in access to insurance because they did not have enough income to purchase personal insurance and also did not qualify for Medicaid (Daaleman & Helton, 2018).
Although the program specifically determines which services should be covered, each state regulates the scope within each category separately. These categories include outpatient services, emergency medical services, hospitalization, care for pregnant women and newborns, psychiatric services, prescription drugs, rehabilitation services, laboratory services, preventive and wellness assistance, and pediatric aid, including dentistry and ophthalmology (Raghupathi1 & Raghupathi, 2018). Later, ACA was modified to provide a more limited list of covered services with a more diverse choice of insurance plans, which has expanded options for different populations.
ACA is being addressed at several regulatory levels because, despite federal regulation, it retains state autonomy in making decisions about insurance options. Additionally, a 2017 reform that repealed some of the provisions of the reform allowed individual institutions to purchase insurance from private companies, which further expanded the number of insurance options. Thus, ACA can be viewed from the perspective of multiple regulation levels. However, the problem of insufficient access of low-income people to health insurance is not fully addressed by this legislation.
Conclusion
NCCDPHP and ACA significantly expand the access of various groups of the population to health care. However, they offer a limited range of interventions available for patients with chronic conditions. Patients with chronic conditions need ongoing coordination of care, which implies the need for increased access to all healthcare professionals. The described initiative and regulations do not solve the problem of inequality in access to care for people of different socioeconomic statuses. NCCDPHP aligns with Healthy People 2030 an initiative that aims to expand healthcare access and improve its quality. These programs do not have conflicting interests but rather complement each other with features that could be combined into a full-fledged effective initiative.
References
Boersma, P., Black, L. I., & Ward, B. W. (2020). Prevalence of multiple chronic conditions among US adults, 2018. Preventing Chronic Disease, 17(E106), 1-4. Web.
Collins, J. L., Marks, J. S., & Koplan, J. P. (2009). Chronic Disease Prevention and Control: Coming of age at the Centers for Disease Control and Prevention. Preventing Chronic Disease, 6(3), 1-6. Web.
Daaleman, T. P., & Helton, M. R. (2018). Chronic illness care: Principles and practice. Springer.
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). (n.d). CDC. Web.
Raghupathi, W., & Raghupathi, V. (2018). An empirical study of chronic diseases in the United States: A visual analytics approach to public health. International Journal of Environmental Research and Public Health, 15(3), 1-24. Web.
Reynolds, R., Dennis, S., Hasan, I., Slewa, J., Chen, W., Tian, D., Bobba, S., & Zwar, N. (2018). A systematic review of chronic disease management interventions in primary care. BMC Family Practice, 19(1). Web.
Teno, J. M., Gozalo, P., Trivedi, A. N., Bunker, J., Lima, J., Ogarek, J., & Mor, V. (2018). Site of death, place of care, and health care transitions among U.S. Medicare beneficiaries, 2000-2015. The Journal of the American Medical Association, 320(3), 264271. Web.
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