Policy over programs: Improving institutional policies so the best healthcare is provided to every patient

Richerson

By Julia Richerson, MD

I love being a pediatrician. To support families on their journey of parenthood is a joy and a privilege. Many days are filled with healthy children whose families are resilient and thriving. Many days, that is not the case.

I work with children who are struggling with issues such as obesity, autism, depression, learning disabilities, diabetes, asthma and rampant cavities. One in four of Kentucky’s children have a chronic or special healthcare need. For them, navigating our healthcare delivery system can be at best overwhelming and at worst, sheer chaos.

Focus on Basic Needs

In addition to health challenges, many of the families I work with face challenges meeting their basic living needs. Having enough food to eat, having a safe and healthy living space, having reliable transportation to work, having safe and reliable child care and living free from domestic violence are some of the basic needs they struggle to meet. Meeting these needs is essential to building health and wellness.

As a pediatrician and a member of my community, I struggle to respond to a family’s challenges. Helping a family with a child with autism navigate the world of medical specialists, therapists and school resources is daunting. Working with a child who is morbidly obese to get the help they need is next to impossible.

As a medical community we can respond better to a family’s needs and support them on their journey to have the best outcomes for their children with special needs like autism and to prevent childhood obesity.

Strong Programs Available

For basic living needs I often respond by referring families to community programs and agencies that can help. We have strong programs in our neighborhoods that offer resources for families. Some offer assistance for immediate needs and some offer more ongoing aid for families struggling or in crises, such as impending eviction or sudden detention of a family member who provided the family’s financial stability.

But if you ask most of these programs, they would be so happy to be “out of business.” Many rely on unpredictable funding and struggle to stay afloat themselves. The dream is for our community not to need a food pantry or a homeless shelter.

Solutions, Not Responses

There are responses to challenges and there are solutions. The healthcare community can play a powerful role in finding solutions. Programs and community resources are responses to problems and are funding dependent.

Solutions can come in the form of policy, at the institution, local and state level. We have a strong history of successful health policies like Medicaid expansion, tobacco free communities and car and booster seat laws. For example, significantly raising the tobacco tax is a policy that would decrease smoking rates in adults and children.

We have a strong history of successful health policies like Medicaid expansion, tobacco free communities and car and booster seat laws.

Patient and Family Centered

We must improve our institutional policies so that the best healthcare is provided to every patient every time and is patient and family centered, such as:

  • Policies that include families in our leadership structure and committees has been shown nationally to improve health outcomes.
  • Instituting policies that support trauma informed care are shown to improve health outcomes.
  • Institution and payment policies that increase timely access to birth control is another example of a powerful solution.

We must improve our institutional policies so that the best healthcare is provided to every patient every time and is patient and family centered.

As we continue to respond in a meaningful way to address health and health disparity issues we must work harder for solutions at the policy level.

Policy, Defined

  • Policy is one potentially effective way to improve the health of populations.
  • Policy is defined as a law, regulation, procedure, administrative action, incentive or voluntary practice of governments and other institutions.
  • Health can be influenced by policies in many different sectors, e.g., transportation policies can encourage physical activity (pedestrian- and bicycle- friendly community design); policies in schools can improve nutritional content of school meals.

-Centers for Disease Control and Prevention

-Julia Richerson, MD, FAAP is a pediatrician at Family Health Centers-Iroquois.

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