SWK 5002 Week 6 Assignment Policy Analysis

SWK 5002 Week 6 Assignment Policy Analysis

 

Student Name

Capella University

SKW5002

Prof. Name

Submission Date

 

Policy Analysis

The VA MISSION Act of 2018 was designed to directly address systemic issues that bedevilled the delivery of care to veterans since at least the VA wait-time scandal of 2014, in which veterans were harmed and, in some instances, died while waiting to receive care. Political attention and media furore resulted in the passage of the Veterans Choice Act of 2014, with only partial access to community-based care, which was railed against as fragmented, administratively convoluted and underfunded (Oh et al., 2022).

Policymakers identified the need for a more integrated, effective and fair system that could address the healthcare inequalities faced by veterans, particularly those in rural, minority and marginalised populations by removing structural barriers to adequate and timely healthcare. The legislation was influenced by bipartisan support and strong advocacy by such veteran service organisations as the American Legion and Iraq and Afghanistan Veterans of America (IAVA).

These groups called for widespread changes that would improve access and better coordinate care, as well as improve the infrastructure of the V.A. The VA MISSION Act was developed in response to this. It encompassed the current community care programs, enhancement of telehealth services, and expansion of caregiver support, as well as the funding of the workforce recruitment and training (Rasmussen & Farmer, 2023). Its enactment moved to a hybrid public-private system of providing veterans with healthcare that would increase choice and flexibility.

• Historical Background Leading to the Policy

The history of the VA MISSION Act goes back decades of underinvestment and bureaucratic dysfunction in the VA healthcare system and the growing dissatisfaction of veterans with the VA healthcare system (Rasmussen & Farmer, 2023). Even before the scandal of 2014, there were already lengthy wait times, geographic inaccessibility, and poor availability for specialised mental health services among veterans.

The outcome of investigations was the finding of tinkered wait-time records, systemic understaffing, and excessive lack of oversight, which was enough to require immediate action of legislation. The Veterans Choice Act of 2014 was an attempt to solve these problems by allowing some veterans to access community care, but soon it was clear that the program was underfunded, providers were not eager to participate, and the program was not well-coordinated.

It was also during this time that there was an increasing awareness of mental health crisis among veterans, such as an increase in Post-Traumatic Stress Disorder, depression, substance use disorder and suicide (Ramchand, 2022).

Even greater disparities were shown in rural veterans, racial and ethnic minorities, and veterans who were part of the LGBTQ + community due to geographic isolation, cultural stigma, and lack of culturally competent care. These social and healthcare issues, combined, make a strong argument in favour of a more thorough policy, which was followed by the creation and subsequent passing of the VA MISSION Act in 2018 as a way to simplify accessibility, enhance equity and resolve systemic gaps.

• Goals of the Policy and How They Are Intended to Be Met

The VA MISSION Act was intended to have four primary objectives, which include increasing access to timely and high-quality care to veterans, improving care coordination between VA and community providers, modernising VA facilities and infrastructure, and improving the support of caregivers of severely injured veterans.

To strive towards these goals, the Act created the Veterans Community Care Program (VCCP), which took different programs, some of which were overlapping, and united them into a single system (Mengeling et al., 2021). This new system established the Community Care Network (CCN), which connected veterans with vetted providers in the private sector if VA services were not available within specific time or distance parameters.

The other important element that was to be expanded is telehealth because it was supposed to minimise geographic barriers, mainly to the rural and homebound veterans. The policy also increased the improvement of caregiver support programs, which funded caregivers with financial stipends, training, and access to healthcare for family caregivers (Miller et al., 2022).

Also, the funding was spent on hiring and sustaining health care staff, refurbishing VA facilities and looking to enhance the technology infrastructure to provide for smooth care provision. All these measures were aimed at ensuring that every eligible veteran, wherever he/she is and whatever he/she is, can get practical, timely, and fair care.

• Effectiveness of the Policy concerning the Target Population

The VA MISSION Act has had quantifiable beneficial impacts on the target population, especially in increasing access to care for the veterans in underserved and rural communities. RAND and VA data reveal that in most areas, the wait time to schedule a community care appointment has been reduced, and the number of tele-mental health visits has gone up between 2020 and 2022 (Farmer, 2022).

The benefits of these gains have been beneficial to veterans with mobility difficulties, veterans who live too far to access the VA facilities, and veterans who need specialised services that are not easily accessed through the VA system.

But the effectiveness of the policy has not been even. Although access has increased for many, there is still a gap between veterans who do not have access to reliable internet access, or lack providers in the location, or meet with local providers who are not aware of military culture and military trauma-informed care.

The VA and non-VA providers have failed to coordinate well, and medical records transfer and follow-up care have been delayed. Accordingly, the Act has moved towards increased equity in the system, but has not eliminated the obstacles of marginalised veteran groups.

• Impact on Social Justice and Social Functioning

The VA MISSION Act can strengthen the social functioning of the target population by enhancing autonomous control, dignity, and healthcare decision-making. Veterans are no longer bound to the confines of their closest VA facility, but they are able to get the care they need promptly, in their communities.

This also saves on travelling costs, reduces interference with daily activities and may increase compliance with therapy. The fact that the caregiver support services are also provided strengthens the support network of the veteran further, which is essential to recovery and transition into civilian life.

The Act is socially just in the sense that it targets historically underserved populations from a social justice perspective in accordance with central values of fairness and equity. Rural veterans, racial and ethnic minorities, and veterans who are members of the lesbian, gay, bisexual, queer, and transgender community have more opportunities to access care that meets their needs (Singh et al., 2024).

Nevertheless, unless community providers are similarly trained in cultural competence, there is still the risk that such groups will experience disparity in the quality and responsiveness of care, which may compromise the aims of social justice in the policy.

• Alignment with Social Values of the Target Population

The values of the veteran community are addressed in the Veterans of America MISSION Act, and those include respect, timely assistance and recognition of the sacrifice in service. It respects the ideal that the best healthcare should be given to the veterans as a nation’s duty by making the care more accessible to them (Kintzle et al. 2024). Veterans tend to place a lot of importance on independence and self-determination, and the policy that focuses on patient choice in care settings promotes those values.

Meanwhile, the policy should address the remaining doubts over the quality of the non-VA care. In the case of veterans who find so much value in the cultural understanding of the providers, the absence of such knowledge in some care environments in the community can be a source of distrust. This is necessary to ensure that the policy fully adheres to the social values and expectations of the targeted population, since care should be based on the lived experience of the veterans.

• Adherence to Best Practice Ethics and Standards

The VA MISSION Act complies with some of the best practice ethics, such as justice (equalising access), beneficence (provision of timely and effective care), and autonomy (increasing choice). The evidence-based telehealth and community partnerships are used, which proves a dedication to innovation and efficiency. The fact that the stakeholders are involved in the process of policy development is also an indication of the ethical responsiveness to the needs of the veteran community.

However, there are no yet deficits in the best practice standards. The lack of a universal training of cultural competence in community providers is a possible violation of nonmaleficence principles since culturally uninformed care may not be harmful, but rather harmful. Moreover, the absence of interoperability between VA and community providers’ systems undermines continuity of care, which is also incompatible with the ethical standard of providing safety to patients by coordinating services.

• Feasibility of the Policy

The VA MISSION Act is highly feasible on a political level, with its passage supported by both parties and still getting support from large veteran service organisations. Its orientation towards the growth of choice, utilisation of the capacity of the private sector, chimes in with a bigger set of political priorities, which prefer public-private partnerships in the delivery of healthcare. Political will to reverse the program is low, although there are arguments over the amount of funding.

The policy is harder economically. Since implementation, community care spending has increased dramatically, which has put doubt on the long-term viability. On an administrative level, the VA has been compelled to invest in IT infrastructure, staff, and provider networks to maintain the increased system. Although these investments increase the feasibility of operations, the shortages and administrative complexity of the workforce remain a challenge towards full and efficient implementation.

• Policy Constraints

Original limits were eligibility limits through distance or wait time restrictions, which restricted access to some veterans even when needed. Although the community care authorisation process is simplified compared to the Veterans Choice Act, it is capable of creating delays. Financial constraints also impeded the modernisation of the infrastructure and the increase in the workforce.

New limits have been established since it was passed. The pandemic of Covid-19 has caused an acceleration of telehealth in general as well as the disparity of digital literacy and access to the internet among veterans, especially older veterans, and veterans living in rural communities (LeBeau et al., 2023).

The budget of the program has been further strained by inflation and increased healthcare costs, and legal wrangles in reimbursement of providers have stagnated the expansion of the network in some areas. In others, they have increased access to the tech-savvy veterans and decreased it for the veterans lacking the resources to use the digital care systems.

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