“Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” -President Obama (Alper, 2014)
Only 3% of national health expenditures are used for preventative services, even though health depends largely on behavioral and environmental factors, rather than medical care or genetics (Alper, 2014). Three major components of healthcare reform are recognized globally, as nations are continuously working to increase access, improve quality, and control costs of healthcare (McDonough, 2014). Since President Lyndon Johnson signed the law establishing Medicare and Medicaid services insurances in the sixties, controlling rising costs of these programs has been concerning. Although his actions primarily aimed to increase access to healthcare, the costs and quality associated with care have been of increasing concern since his presidency. In 2010, President Barack Obama signed the controversial Affordable Care Act (ACA) into law, hoping to address many of the new issues that have emerged in healthcare. The launch of marketplace sites to purchase healthcare, came with many problems for customers, and many of the reforms have made complete repeal of the ACA unlikely.
The ACA has components that were intended to remedy problems associated with limited health literacy, but two other major initiatives were also introduced in 2010, which also strived to address problems associated with health literacy (Koh, et al., 2012). These were the National Action Plan to Improve Health Literacy, by the Department of Health and Human Services (HHS), and the Plain Writing Act of 2010. Policies, which improve health literacy and promote language that is easy for readers to understand, are essential for the population with diabetes and pre-diabetes. A cross-sectional study in St Louis, Missouri reported findings indicating most patients with diabetes are unintentionally nonadherent to treatment plans, suggesting educational interventions may be helpful and should be designed for patients with limited health literacy (Fan, Lyons, Goodman, Blanchard, & Kaphingst, 2016). Patients’ attitudes toward their diabetes were investigated using questionnaires, revealing that many people with diabetes may not understand the HbA1C level, and may need simpler explanations of key diabetic concepts, with less medical jargon (Elliott, Harris, & Laird, 2016).
Features of the ACA, which focus on patient-centered care, may be the most popular portions of the legislation (Koh, et al., 2012). Since findings suggest patients are usually unintentionally nonadherent to treatment plans, educational programs can be helpful in the treatment of patients with diabetes (Fan, et al., 2016). Diabetes self-management education and support (DSMES) is supported by a large body of evidence, in demonstrating that it can improve knowledge of disease, self-care, HbA1C, weight, mortality, coping, and quality of life, while decreasing weight and costs (ADA, 2018). These programs focus on the individual’s values, while responding to and respecting the patient’s preferences and needs. The goals of the patient-centered treatment plan for a patient with diabetes should focus on decreasing complications and maintaining, or improving, quality of life. Of course, to improve quality of life, one must first assess what this would mean to the individual. Nonjudgemental, empathetic approaches, using empowering language, are suggested for patients with diabetes, rather than blaming them for “noncompliance” (ADA, 2018). Public sector policies can affect diabetes care significantly by regulating funding and healthcare requirements and promoting health literacy, but the terminology that is used in the legislation needs to be carefully selected.
References
Alper, J. (2014). Population health implications of the affordable care act:Workshop summary. Washington, DC: The National Academies Press.
American Diabetes Association. (2018). Standard of medical care in diabetes – 2019. Diabetes Care 2019, 42(Suppl. 1). doi: 10.2337/dc190Sint01
Elliott, A. J., Harris, F., & Laird, S. G. (2016). Patients’ beliefs on the impediments to good diabetes control: A mixed methods study of patients in general practice. British Journal of General Practice, 66(653), e913–e919. doi:10.3399/bjgp16x687589
Fan, J. H., Lyons, S. A., Goodman, M. S., Blanchard, M. S., & Kaphingst, K. A. (2016). Relationship between health literacy and unintentional and intentional medication nonadherence in medically underserved patients with type 2 diabetes. The Diabetes Educator, 42(2), 199–208. doi:10.1177/0145721715624969
Koh, H., Berwick, D., Clancy, C., Baur, C., Brach, C., Harris, L., & Zerhusen, E. (2012). New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly ‘crisis care’. Health Affairs (Project Hope), 31(2), 434-443. doi: 0.1377/hlthaff.2011.1169
McDonough, J. (2014). Health system reform in the United States. International Journal of Health Policy and Management, 2(1), 5-8.
Expanding Financial Coverage for Education and Treatment of Pre-diabetes 