Aim of assignment
The purpose of this essay is to enable students to gain insight into health and socio-political issues in aged care as well as evaluate and critique health service delivery for older people. On successful completion of of this assessment task students will met the following learning outcomes.
1. Critique representation of older people in policy, laws and legislation and health/social service delivery.
2. Evaluate the rationales for resource allocation, service provision and co-ordination of services for older people.
3. Critique models of health service delivery for older people , including models of wellness, user-pays, case case management and active ageing.
In this assessment you are required to critique primary health care for older people living in the community.
Points to remember:
1. explanation of primary health care for older people.
2. evaluation of the ways resources are allocated and services are provided using a primary health care approach.
3. Critical discussion of primary health care service delivery for older people.
Primary Healthcare for Older People
As the world is ageing owing to better healthcare facilities, the importance of primary healthcare has been under focus for quite some time. The increase of medical practitioners across the world has improved the primary health care especially in the developed markets. As far as the elderly is concerned, the frequent diseases that they have needs to be diagnosed properly before being given proper medications and experts in this field help in assisting the whole process. The essay will look to focus on the ways through which resources have been distributed in the wellness sector along with an in-depth analysis of the health-care accessibility among the aged population.
Primary health care for older people
As per reports by The Economic Intelligence Unit, the global annual health spending is expected to touch $8.734 trillion by 2020. The primary reason behind this includes an aging population, prevalence of chronic diseases and wasteful spending in the industry. The Deloitte report also says that between 2016 and 2021 the life expectancy is expected to rise to 74.1 years compared to 73 some years back. Freedman and McDougall (2019), have observed that as per trends by 2021, people aged above 65 years will reach 656 million, which will be 11.5% of the total population. So taking a cue from this it is quite visible that as the older population continues to grow, the prevalence of chronic diseases will move along the same trajectory. Diabetes, Parkinson’s disease, cardiovascular disease, COPD (chronic obstructive pulmonary disease) and dementia is rising constantly among the elderly people. As said by Gundry (2019), 95% of dementia cases are found among people who are over 65, 75% cases for Parkinson’s, malignancies occur at 85% and this is why the trends have become concerning for medical professionals and apart from specialists in corporate hospitals, the importance of a primary healthcare network has been felt heavily.
It has been often found that unhealthy lifestyle, stress and depression as well as ignoring symptoms of illness are the basic reasons for the elderly population to get affected heavily. McKelvie et al. (2019), in a detailed survey noticed that even in developed nations like the North American countries, Nordic nations or European union happiness and a highly inclusive society has still not been able to tackle the problems of decreasing health condition. Excessive smoking, drinking and obesity are the most important cause of cardiovascular diseases. Hence Davies et al. (2019), stated that as per WHO (World Health Organization) directives the growth of primary care needs to be expanded to the farthest corners of a country for basic treatment and diagnosis of diseases. Globally the situation of primary healthcare is still far from ideal, as half the world’s population don’t have coverage of essential health services. The older population needs at least 18 million health workers as per WHO report. In an extremely worrying trend, out of 30 countries surveyed in 2019 February, only 8 spends more than $40 per person which is a huge problem if not addressed immediately (Gundry, 2019).
Resource allocation and service delivery in primary health care
The resource allocation in the primary healthcare sector has been extremely uneven as developing nations are unable to find a balance between public and private healthcare sectors leading to massive disparity in cost of treatment and quality of services. Crump et al. (2019), has suggested that governments must view healthcare as a necessity and not a luxury; so it is important to implement fully public healthcare system to avoid the issue of affordability. France for instance has one of the best primary health centers network for the aged population. As of 2016, their life expectancy has been 82.27 years and the government expenditures on primary health are around 12percent of GDP, out of which 76.6% is publicly financed. The country had 221,000 general practitioners and 119,000 specialists which provide personal care even in the remotest corner of the country (McKelvie et al. 2019).
In the words of St John et al. (2019), addressing the problems of the older population is the most important part of primary health-care system. The Social Capital Approach, which talks about the involvement of communities in building an equitable and inclusive society, has been used by countries like UK, Netherlands, US and several other advanced nations. The doctors in the primary health centers treat the whole person which is far advanced than narrow clinical diagnosis. Insurance companies have also been able to bring in individuals from economically disadvantaged senior citizens through discounted schemes, flexible payment options and longer duration to pay back. In USA, 250 million people enjoy primary healthcare facilities as they are insured (Chang et al. 2019).
The quality of medical practitioners is huge problem in primary healthcare industry. As most doctors prefer to serve in the cities and townships, the rural segment remains completely neglected. In countries like India, Bangladesh, Myanmar the quality of healthcare for the older people is pathetic. There have been instances of fake doctors, fake patients, international smuggling rackets linked with primary health sectors and mistreatment of patients leading to paralysis and death. Furthermore the increasing dominance of private healthcare organizations including clinics, hospitals, and training and rehab centers has increased the overall healthcare expenses of the people. Chang et al. (2019), suggested that the health expenditure for older individuals is expected to increase from $7439 in 2015 to $9594 in 2035. There will also be an increase in the absolute expenditure from $166 billion to $320 billion, for people living without additional morbidity. Considering this it has become extremely important that most organizations, governments, NGOs, and private practitioners come together in order to reduce this massive out of the pocket expenditure in poorer countries, and build a sustainable public model which is present in the advanced nations.
Critical analysis of primary health care services for older people
Ageing and healthcare issues needs to be addressed through continuous engagement with patients and analyzing the difference between their expectations and reality. The marginalized section of the community finds it extremely difficult to access healthcare in most emerging markets. In the U.S. “Medicare for All” is the new slogan for citizens who believe that the most powerful country has severed deficiencies in healthcare. Currently 59.7 million senior citizens are eligible for this scheme, as they are 65 or above. Beneficiaries pay premiums, deductibles and also take help of long-term care like vision and dental treatment (Freedman and McDougall, 2019).
As per Benraad et al. (2019), the Healthy Ageing model reveals important areas of focus which should be addressed by the medical fraternity. The model has four stages which includes client-centered perspective, goal-driven approach, coaching strategy of health behavior and recognizing broader health context of the patient. So when an aged person goes for treatment in the primary health care center sufficient time should be given in order to understand the medical history of the patient. This is the client perspective, followed by personalized healthcare initiatives and facilitates counseling methods as and when required for the older population for comprehensive health coverage. Yin et al. (2019), have stated that a research in Minnesota and Wisconsin among 272 patients revealed that doctors interrupt patients within 11 seconds of their speech and 64% primary care doctors did not even bother to ask the purpose of visit. It clearly shows the deep rooted problems of commercializing the health-care industry where the interests of medical practitioners are more towards monetary benefits compared to disease diagnosis.
Observing this trend of neglect among the primary care physicians, WHO has strongly advocated for more geriatricians to take care for the elderly. This is supported by Reed et al. (2019), who have noticed that the capability of long-term treatment for older people is possible only through expert geriatricians who can take control of the patient and provide the necessary treatment. The healthcare insurance market, which is expected to touch $2.2 trillion by 2024, is also focusing on the aged population for more inclusive packages. The shortage of primary physicians has shot up their salary to $309, 431 in Nevada (US), which is increasing the overall expenditure of the patients as well (Yin et al. 2019). Experts in the medical field, believes that highly specialized primary physicians are too few to deal with this ageing problem. So either the government built an intensive network of primary health centers with trained professionals, or they must look for public health system to take over.
As discussed above, the importance of primary health-centers are extremely important force treatment of the older population. However the lack of time given to patients, lack of training and increasing expenses is making it difficult for older people especially from the economically backward class to afford these treatments. As the population is ageing hence it has become important for institutions and the healthcare fraternity to provide accessible healthcare to older people. The reality however, is far from that and public spending on healthcare must increase in the next decade to improve the mortality rate and reduce chronic diseases in the long-term.