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Legislative History
The concept of chronic illness commenced gaining importance in the national policy field during the first half of the 20th century. This process was inherently linked to a decrease in the burden of infectious diseases and infant mortality (Fallon, 2016). However, as Fallon (2016) states in her review of George Weisz’s book Chronic Disease in the Twentieth Century, non-acute illnesses became a major national health problem also due to the emergence of new practices and tools aimed to detect “silent” sicknesses in adults who seemed to look healthy (p. 239). Besides, the results of surveys conducted in different states identified links between individuals’ welfare and chronic diseases (Fallon, 2016). However, explorations of chronic diseases were initially concerned merely with conditions experienced by working-age people. Thus, many US public health organizations, such as the Commission on Chronic Illness, tended to separate chronic diseases and aging-related health problems and proposed to approach their management and prevention separately (Fallon, 2016). It means that the concept of chronic disease entered the national policy discussion before the 1950s only due to the significance of the issue about the employment-associated and economic challenges.
Another important factor that contributed to an increase in the importance of chronic illness within the national policy debate was the expansion of researchers’ interest in the study of such chronic illnesses as osteoporosis. According to Fallon (2016), in the late 1940s-50s, the links between the disorder, menopause, and estrogen loss were found in older women. These findings not only prompted the development of new osteoporosis treatments but also made researchers question the role of the aging process in chronic disease progression (Fallon, 2016). Eventually, aging started to be viewed as “distinct from pathological processes of disease,” whereas clinical interventions began to be regarded as means to prevent pathological aging and promote the healthy one (Fallon, 2016, p. 241). In other words, when it comes to chronic disease in older adults, practitioners and policymakers started to focus more on the maintenance of their functional status and preclusion of disease-associated functional loss.
The first policy that directly addressed chronic illness in older adults was the Medicare Amendment to the Social Security Act (1965). Along with Medicaid, Medicare was enacted as “Title XVIII and Title XIX of the Social Security Act, extending health coverage to almost all Americans” of age 65 or more (“Key milestones,” 2005, p. 1). The purpose of the coverage program was to improve the quality of services and enhance access to healthcare among all Americans regardless of their level of income and social status (Huffman & Upchurch, 2018). Clearly, with the enactment of Medicare, more adults of advanced age obtained opportunities to address their chronic health problems.
However, despite large population coverage, significant disparities in individuals’ access to care and the incidence of diseases still existed after the implementation of Medicare and Medicaid. Therefore, in 2005 the US government also introduced the Patient Navigator Outreach and Chronic Disease Prevention Act (Committee on Health, Education, Labor, and Pensions, 2005). The goal of the policy is to help diverse individuals to overcome different-level barriers to care and enhance their adherence to evidence-based treatment recommendations (McBrien et al., 2018). Considering that older adults are at increased risk of chronic disease development, morbidity, and mortality and may lack sufficient understanding of their insurance, the policy targets this population group to a large extent.
Major Features and Components of Programs
It is valid to say that Medicare provides older adults with an extensive number of opportunities to address their chronic conditions. Besides initial coverage for hospitalization, outpatient services, and healthcare practitioner fees, the program now also includes prescription drug coverage (Huffman & Upchurch, 2018). Nevertheless, Medicare does not cover costs for hearing aids and eyeglasses and it reimburses only short-term expenses for long-term care and at-home services (Huffman & Upchurch, 2018). It means that some medical procedures and treatments may be inaccessible for older adults with chronic diseases due to their costliness.
As for the patient navigator programs, they aim to close gaps in the treatment of disparate chronic diseases among the members of vulnerable populations. Initially, the act primarily addressed the problem of cancer intervention, yet now it is possible to find programs targeting people with diabetes, heart disease, chronic kidney disease, HIV/AIDS, dementia, and many other disorders (McBrien et al., 2018). The components of the navigator programs usually vary as well. They may include patient education regarding their diseases, healthcare system, and community resources; assistance with insurance coverage; provision of psychological support; care coordination; and development of personalized treatment plans (McBrien et al., 2018). Nevertheless, the common feature of all navigator programs is that they are delivered by trained personnel: nurses, social workers, and even peers (McBrien et al., 2018). Overall, the navigator programs may be considered promising in terms of helping older adults to access the resources needed to manage their chronic conditions. However, considering the discrepancies in the programs’ features and components depending on their location and purposes, it is hard to tell how effective they are in this regard on the national level.
References
Committee on Health, Education, Labor, and Pensions. (2005). Patient navigator outreach and chronic disease prevention act of 2005. Web.
Fallon C. K. (2016). Chronic disease in the twentieth century: A history: Aging bones: A short history of osteoporosis. Journal of the History of Medicine and Allied Sciences, 71(2), 238-242.
Huffman, K. F., & Upchurch, G. (2018). The health of older Americans: A primer on Medicare and a local perspective. Journal of the American Geriatrics Society, 66(1), 25-32.
Key milestones in Medicare and Medicaid history, selected years: 1965-2003. (2005). Health Care Financing Review, 27(2), 1-3.
McBrien, K. A., Ivers, N., Barnieh, L., Bailey, J. J., Lorenzetti, D. L., Nicholas, D., … Manns, B. (2018). Patient navigators for people with chronic disease: A systematic review. PloS one, 13(2), 1-33.
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