SKW 5002 Week 6 Assignment Policy Analysis

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Policy Analysis

Student Name

Capella University

SKW5002

Prof. Name

Submission Date

Policy Analysis

The VA MISSION Act of 2018 was formulated to directly respond to systemic problems that had bedevilled care delivery to the veterans since at least the VA wait-time scandal of 2014, where the veterans were harmed and, in other cases, died whilst waiting to be attended to. The enactment of the Veterans Choice Act of 2014 with partial access to community-based care (only) came as a result of political concern and media outrage that was decried as disjointed, administratively inbursive and underinvested (Oh et al., 2022).

Policymakers realised that there was a need to have a more integrated, effective, and equitable system that could tackle the healthcare disparities experienced by the veterans, especially in the rural, minority, and marginalised groups, by eliminating the structural barriers to good and prompt healthcare. The support of bipartisanship and advocacy by such veteran service organisations as the American Legion and Iraq and Afghanistan Veterans of America (IAVA) all had an influence on the legislation.

These groups demanded extensive reforms to enhance access and better coordinate care, and also to enhance the infrastructure of the V.A. This led to the development of the VA MISSION Act. And it included the existing community-based care programs, telehealth service improvements, and caregiver support, as well as the funding of the workforce recruitment and training (Rasmussen and Farmer, 2023). Its implementation shifted towards a hybrid form of combining both a public and a private system of delivering healthcare to veterans, which would enhance choice and flexibility.

Historical Background Leading to the Policy

The VA MISSION Act has a decades-long history of poor investment and bureaucratic ineffectiveness in the VA healthcare system, and the increasing discontentment of the veterans with the VA healthcare system (Rasmussen and Farmer, 2023). Even pre the 2014 scandal, there were already long wait lines, inaccessibility due to geography, and poor accessibility to specialised mental health services among the veterans.

The results of inquiries were the discovery of falsified wait-time sheets, institutional understaffing, and an overabundant absence of regulation, which sufficed to warrant urgent measures of law. One of the attempts to address these issues was the Veterans Choice Act of 2014, according to which a certain number of veterans would be allowed to receive care in the community, but it became obvious quickly that the program was insufficiently financed, providers were not keen on joining it, and it was not properly coordinated.

It was also in this period that mental health crisis was becoming more and more awareness of veterans, including a rise in Post-Traumatic Stress Disorder, depression, substance use disorder, and suicide (Moore et al., 2023). Even larger differences were observed in rural veterans, racial and ethnic minorities, and veterans of the LGBTQ+ group because of geographic isolation, cultural stigmatisation, and inaccessibility to culturally competent care.

The combination of these social and healthcare concerns creates a solid case for advocating a more comprehensive policy, which was succeeded by the development and subsequent enactment of the VA MISSION Act in 2018 to streamline the accessibility process, improve equity, and eliminate systemic gaps.

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

The VA MISSION Act was supposed to achieve four main goals, which are to enhance access to high-quality care and timely care to veterans, enhance the coordination of care between VA and community providers, modernise VA facilities and infrastructure, and enhance the support of caregivers of severely injured veterans.

To pursue these objectives, the Act established the Veterans Community Care Program (VCCP), that brought together various programs, some of which overlapped each other, and combined them into a single system (Mengeling et al., 2021). This new system was the Community Care Network (CCN) that linked veterans to vetted providers in the private sector in case VA services were not available within a specific time or distance limit.

The second relevant aspect that should have been extended is telehealth, since it was to be used to reduce the geographic barriers, primarily to the rural and homebound veterans. The policy also enhanced the enhancement of caregiver support programs, which provided caregivers with monetary stipends, training, and availability of healthcare to family caregivers (Miller et al., 2022).

In addition, the funds were used to recruit and retain the healthcare personnel, rehabilitate the VA structures, and seek to improve the technology to facilitate unhindered care delivery. All these were to provide that all eligible veterans, regardless of his/her location and status, can receive practical, timely, and acceptable care.

Effectiveness of the Policy concerning the Target Population

The VA MISSION Act has demonstrated measurable positive results to the target population, particularly in providing more access to care to the veterans in underserved and rural communities. According to RAND and VA data, the wait to book a community care appointment in most regions has decreased, and tele-mental health visits have increased both in 2020 and 2022 (Farmer, 2022). These gains have proved advantageous to the veterans with mobility challenges, the ones living too far to use the VA facilities, and those who require specialised care which cannot be easily obtained by the VA system.

However, the policy has not been effective across the board. Even though the access has improved among a wide range of people, there remains the disparity between veterans lacking access to reliable internet access, or providers in the area, or having an encounter with local providers who are unfamiliar with military culture and military trauma-informed care. The non-VA and VA providers have not been very good in coordinating their services, and medical records transfer and follow-up services have been delayed. The Act has therefore lent towards a more equitable system, although it has not erased the hurdles of marginalised groups of veterans.

Impact on Social Justice and Social Functioning

The VA MISSION Act. Veterans are no longer restricted to the boundaries of the closest VA hospital, yet they can receive the care they require as and when they are required, in their local community. It also saves on travelling expenses, lessens interference with everyday activities, and may enhance adherence to therapy. The fact that the caregiver support services are also offered further empowers the support network of the veteran, and this is vital to recovery and reintegration into civilian life.

The socially just aspect of the Act is that it aims at addressing underserved groups of people, historically based on social justice, within the framework of the core values of fairness and equity. More opportunities are available to rural veterans, racial and ethnic minorities, and veterans who belong to the lesbian, gay, bisexual, queer, and transgender community to receive the services that satisfy their needs (Singh et al., 2024). However, as long as community providers are not also culturally competent trained, there remains the possibility that disequity in quality and responsiveness of care may manifest in such groups, and this fact may undermine the social justice goals in the policy.

Alignment with Social Values of the Target Population

The Veterans of America MISSION Act tackles the values of the veteran community, and they are respect, timely help, and recognition of the sacrifice in service. It adheres to the principle that the most optimal healthcare is given to the veterans as the responsibility of the state by ensuring that the care is made more accessible to them (Kintzle et al. 2024). Independence and self-determination are highly valued by the veterans, and the policy that emphasizes patient choice in care settings supports these ideals.

In the meantime, the policy must take into consideration the outstanding skepticism regarding the quality of the non-VA care. The lack of such knowledge in certain care settings within the community may be an issue of distrust in the case of veterans who hold much of the cultural understanding of the providers. This is to ensure that the policy is well guided by the social values and expectations of the targeted population, as the care should be guided by the lived experience of the veterans.

Adherence to Best Practice Ethics and Standards

The VA MISSION Act adheres to some of the best practice ethics, including justice (equalising access), beneficence (provision of timely and effective care), and autonomy (increasing choice). It applies the evidence-based telehealth and community partnerships, which is an indication of commitment to innovation and efficiency. The ethical responsiveness towards the needs of the veteran community is also manifested by the fact that the stakeholders are involved in the process of policy development.

Nevertheless, the best practice standards lack deficits at the moment. This is a potential breach of the nonmaleficence principles, as culturally uninformed care could not be harmful, but, on the contrary, harmful. In addition, the lack of interoperability between the systems of VA and community providers sabotages continuity of care, which is not compatible with the ethical principle of offering safety to patients through service coordination.

Feasibility of the Policy

The VA MISSION Act is extremely viable on the political front, both parties supported its adoption, and large veteran service organisations continue to support it. Its disposition towards the development of choice, exploitation of the potential of the private sector, resonates with a larger group of political agendas that favor the idea of public-private collaboration in the healthcare provision. The will in the political sphere to turn the program back is low, yet the volume of funding is a point of contention.

The policy is more difficult in terms of the economy. The community care expenditure has been growing at an unprecedented rate since its implementation, making the long-term sustainability questionable. At the administrative level, the VA has been forced to allocate funds into IT infrastructure, human resources, and provider networks to sustain the expanded system. Even though these investments make operations more viable, the shortages and complexity of the workforce administration are still a problem in the way of full and efficient implementation.

Policy Constraints

Original eligibility limits were restrictions in the shape of distance or wait time limits that made some veterans inaccessible when needed. Though the community care authorisation procedure is made easier than veteran choice act, it can cause delays. Another problem was the financial limitations that hindered the modernisation of the infrastructure and the accelerated workforce.

Since its enactment, it has given rise to new boundaries. The Covid-19 pandemic has resulted in an increased pace of telehealth, both in general and in the lack of digital literacy and access to the internet between veterans and those who live in rural communities (Shaver, 2022). Inflation and high healthcare expenses have further worsened the budget of the program, and legal wrangles regarding reimbursement of providers have stalled the growth of the network in some regions. In others, they have enhanced access to the technologically advanced veterans and reduced it among the veterans who do not have access to the digital care systems.