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Introduction
On November 2, 2004, the state of California passed an initiative associated with increasing financial support for mental health care. Known as Proposition 63, the plan facilitated the creation of the Mental Health Services Act that implied the dedication of funds for mental health services through imposing a 1% tax on personal income over $1 million (Bambauer, 2005). The success of the Proposition lied insignificant support from the population not only due to the positive intent but also because of the economic viability. The tax increase would only be paid by less than 0.1% of California’s population, which showed that people would support the rise in health-related spending if they were not responsible for them.
This paper aims to analyze the Proposition 63 policy from the perspective of four processes, which include identification and definition, economic viability evaluation, analysis of values, as well as strategy and planning. The report is intended to reveal the reasons behind the policy’s implementation, the economic benefits or limitations associated with its establishment, point to the core values brought by the policy, as well as reflect on the peculiarities of strategy implementation and planning as to increasing financial spending on Californians’ mental health.
The principal focus of the assignment pertains to reaching high levels of public satisfaction with the implemented policy. Healthcare policies are high on the agenda for populations because of the need to address pervasive issues that decrease citizens’ quality of life. As mentioned by the Kaiser Family Foundation (2011), health issues exacerbate when uninsured populations, which do not have the means to pay for services, are more likely to skip needed care. Mental health care is especially overlooked among such populations when the availability of financial resources is not enough to implement the appropriate set of care practices to relieve the burden of mental health issues.
Policy Analysis Process of Identification and Definition
Identifying and defining a problem that is necessary to address with the help of a statewide policy is among the first steps of policy analysis. When there is lacking understanding associated with a problem and the inability of competent individuals to solve it, several conditions apply. For example, there may not be a shared understanding of the nature of the problem, or there may be a shared understanding that does not apply to a given situation (McLaughlin & McLaughlin, 2015). Besides, there may be relevant and realistic understanding, but the issue may not be in the interest of stakeholders to resolve. Finally, in the case of the Proposition 63 policy in California, the state government understood and shared the desire to address the issue of mental health care among the population, the resources were insufficient and had to be allocated from a reliable resource.
In the process of policy analysis and definition, there is the need to reach an agreement on several crucial areas. The first point is the relevant definition of health, which, in the case of Proposition 63, pertains to offering the population struggling with mental health issues would have access to a safe living environment, supportive relationships, the ability to weather the crisis, and sustain overall psychological and physical health (Bambauer, 2005). The second point is the definition of the target population, which implies the group of Californian citizens that require support from mental health care services and are unable to continue funding their care. The establishment of the Mental Health Services Act initiated by Proposition 63 will increase access to relevant services for the target population.
The third point is the current of the potential status of the targeted population’s health. In California, nearly one in six California adults have mental health needs while one in twenty has a severe mental illness that makes it complicated to carry out major life activities (California Health Care Foundation, 2013). While this data was measured after Proposition 63 implementation, the health status of Californians remains relevant to the policy. The fourth point pertains to the factors that would determine the health status of concern with the population. While the factors would depend from one case to another, the social determinants of health apply to the discussed policy. Physical health, education levels, welfare, housing, income, and relationships influence the mental health of the population, and Proposition 63 aimed to address the challenges.
The fifth point pertains to the methods that are realistically available to change the health status. In the Proposition 63 policy, the increase of mental health care funding is the method used for addressing the healthcare problem at hand. Through increasing taxes for individuals earning more than $1 million per year, it is possible to increase the funding for mental health services available to the citizens of California (Bambauer, 2005). With the new system, the flexibility of local spending decreased for non-mental health-associated purposes despite the fact that counties would receive more significant funding for mental health services. Therefore, with Proposition 63, there was more money, stronger support from the general population, and more appealing arguments
The sixth point included the responsibility of the different actors in dealing with the identified problems. Since the Mental Health Services Act was intended to provide access to needed mental health services for vulnerable populations, the responsibility falls on healthcare providers and policymakers in the sphere of health. It should be noted that concerns existed among stakeholders as to how funds should have been allocated, how their needs would be assessed, who would benefit from services, and how the outcomes would be evaluated. Therefore, the policy is limited in the area of guiding the practice of relevant stakeholders and supporting them in the decision-making process.
The final point is associated with societal values that would guide the selection of policy alternatives and the acceptability of alternative outcomes. The question of whether other states should have followed the lead of California in regards to the Proposition 63 illustrates the potential value of the policy. Alternatives that could be relevant include the taxations of individuals earning less than $1 million per year, which would inevitably increase funding on mental health care services. However, it is likely that the policy would not receive the same level of support, as shown initially because more people would be responsible for contributing to it financially.
Policy Analysis Process of Evaluation of Economic Viability
The policy analysis process regarding the evaluation of economic viability is imperative because it is concerned with resource allocation in cases when they are scarce. Economic viability is determined through answering questions such as how much the policy will cost, what value will be received from money, how does the value compare with other alternatives that are being considered, as well as how payment will be allocated when it comes to the services that should be put into place. Given the analysis of the changing supply and demand, it is necessary to decide on the approaches that would be the most promising. For example, it is essential to establish the cost of the illness, including quality-of-life influences. According to Bambauer (2005), funding allocation for each city in California required a minimum of $75,000 each, also accounting for the proportions of mental health disorders with an income of less than 200% of the federal poverty level.
After understanding the burden of the healthcare issue, it is essential to determine the difference between the intervention and the status quo ante, thus conducting a cost-minimization study (McLaughlin & McLaughlin, 2015). The intentions of the policy were not to minimize the costs but rather to increase funding on mental health services for the population of California. However, the policy did not account for the large budget deficits in the state, which meant that cost minimization would be nearly impossible. In addition, there are doubts as to whether supplemental funds allocated from Proposition 63 would be fully protected as planned initially. Therefore, the policy is significantly limited in the area of cost minimization as it does not provide a reliable system for planning and protecting the newly-allocated resources.
Policy Analysis Process of Analysis of Values
Any final policy will take into account the values that would be reached. In regards to Proposition 63, it is important to consider such values as equitable access, efficiency, patient privacy and confidentiality, personal responsibility, quality, variability, and malpractice, professional ethics, social welfare, and process equity. The target group of individuals included in the policy includes vulnerable populations of California who lack the resources to seek quality and accessible mental health services. Therefore, the issue of equitable access and social welfare was placed at the forefront of the policy. It was also expected to improve the quality of services associated with mental health that would be provided to the population with the increase in funding for the underserved population. Quality is especially relevant to the policy that is being analyzed because of some of the criticism. The opponents of the policy attacked Proposition 63 for failing to consider whether mental health care services would work for the target population. However, research had shown that if remained untreated, severe psychological issues could cause problems such as disability, suicide attempts, as well as decreased life productivity that contributes to homelessness, incarceration, and the use of health services (Bambauer, 2005).
However, the increase of social welfare as related to the policy was implemented at the detriment of a singled-out group of income earners that would be forced to raise revenue for the target group. When it comes to the applicability of Proposition 63 to other states, it is unclear whether the same values would be possible to reach. Not all states allow for the ballot initiative process and would be unable to support the target population of vulnerable citizens who do not have the financial resources to address their health care needs. In California, the involvement of high-income taxpayers relates to the process equity, which implies the need to perceive the process as fair. For instance, when the policy was being settled, it was necessary to consider whether all interested parties participate. The development of Proposition 63 showed that significant collaboration among relevant stakeholders occurred in order to establish the framework that would serve as the basis for the policy. The considerable support from the public was imperative for deciding in support of the 1% tax, and the previous reductions of taxes for the riches would not be covered by the insignificant increase intended to support mental health care for the population. Therefore, the increase would not have had any detrimental influence on the allocated taxpayers while strengthening the process equity component related to the policy.
Despite the overall positive support for Proposition 63, the way in which its success would be measured was a limitation of the policy. As related to the definition of health within the policy, which involves a safe living environment, ability to get assistance and weather crisis, as well as reaching physical health, the outcome measures would be broad, hard to measure, and beyond the scope of the legislation. In addition, California is unique in the sense of being able to apply the policy because of the most significant disparity between the highest-earning and the lowest-earning citizens, and the large numbers of millionaires would be capable of supporting the tax increase intended to address the issue of the inadequate access to mental health services.
Implementation Strategy and Planning
The policy process is expected to consider the ways in which policy should be implemented as well as how it should be promoted. Importantly, the strategy and planning also rely greatly on the regional aspect of policy. As related to the policy that is being discussed, it is imperative to consider the context within which the policy was proposed, planned, and implemented. The deinstitutionalization of mentally ill individuals across the United States had presented a significant issue for largely-populated states because of the need to serve a broader spectrum of patients (McLaughlin & McLaughlin, 2015). To make the policy successful within such a complex environment, it was necessary to create a plan that would address the critical challenges associated with the mental health of the population. Previous attempts related to increased spending on mental healthy repeatedly failed in the legislature. However, with the help of Proposition 63, the issue could be resolved in California directly, with attention being paid to the characteristics of the state legislature as well as the economic capabilities of the state. In other regions, the legislation would not have been as successful because of the inability to dedicate millions of dollars to provide mental health services to the population.
With the scope and the funding for the policy already understood, it is imperative to consider risk management as one of the stages of implementation and planning. In regards to the current policy, the main risks included the possible shortage of human and monetary resources as well as the lack of supports and infrastructure. These challenges were not fully addressed in the planning and implementation of the policy due to the primary focus placed on the financial aspect of care. It could have been useful for the policy to include considerations of these challenges because it was unclear how the lack of resources will be addressed in order not to decrease the quality of care as well as how new supports and infrastructure would be developed. Because of the mentioned limitations, other states would not have the capability to follow the example of California, which had more resources to address the pervasive problem associated with mental health care in the state.
Stakeholder engagement is another planning and strategy issue that the policy does not explore in great detail. According to McLaughlin and McLaughlin (2015), policy implementation must have a stakeholder review to mention such important aspects as who needs to be informed about the policy, who should participate in detailed planning activities as well as what activities would be put in place, who should be the opinion leader of the program’s champion, who is the enabler, and so on. Proposition 63 does not identify the level of commitment needed from stakeholders, how it should be secured, as well as what messages should be delivered during the process of implementation. It should also be noted that the policy did not consider such components as shared responsibility and leadership. The focus on the financial resources within the process of policy implementation lacked the explanation of who would be responsible for assigning important tasks that would lead the policy toward its success.
The lack of clarity regarding the meaningful collaboration between stakeholders is a significant program limitation, which would inevitably influence the legislation during its implementation stage. Nevertheless, despite the limitations of the legislation in the areas of implementation planning and strategy, the overarching support for Proposition 63 illustrated the overall positive outlook on mental health care in the state, even though the legislators did not address several important points that could have enhanced its implementation.
Conclusion
The importance of Proposition 63 passed in California was linked to the state’s increased attention to the mental health needs of underserved populations, who are largely uninsured and low-income, which meant that they did not have the financial support to address their needs. Placing a 1% tax on the adjusted gross income of earning more than $1 million was an innovative approach toward the allocation of financial resources for mental health care, and meant that the rich citizens would be contributing positively to the state’s healthcare needs. The overall intentions of the policy were to expand the availability and scope of mental health services through the establishment of integrated services for citizens who do not possess enough resources to compensate for their mental health care.
The policy analysis process pointed to several limitations of Proposition 63, which presented significant limitations within the implementation process. The policy did not consider the relationships between relevant stakeholders to carry out the developed set of strategies. In addition, risk mitigation was not addressed, which is a significant limitation of the policy both at the stages of preparation and carrying it out in real life. The success of the policy was attributed to the high levels of support from the population, which showed that Proposition 63 addressed the core values associated with the health care needs that the citizens encountered. However, following the lead of California was not something that other states could do because of the uniqueness of the state in the distribution of income among populations as well as the ballot system that allowed to pass the legislation.
References
Bambauer, K. (2005). State mental health policy: Proposition 63: Should other states follow California’s lead? Psychiatric Services, 56(6), 642-644.
California Healthcare Foundation. (2013). Mental health care in California: Painting a picture. Web.
Kaiser Family Foundation. (2011). Public opinion and health care policy. Web.
McLaughlin, C., & McLaughlin, C. (2015). Health policy analysis: An interdisciplinary approach. Jones & Bartlett Learning.
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