Healthcare Policy Issues
QUESTIONS:
1. Explore the critical healthcare policy issues affecting healthcare access, cost, and quality. Describe at least one issue that relates to each principle.
2. How does the Affordable Care Act address each of these variables?
3. Define health policy in the context of the US government. Expound on the scope and role of such.
4. Critically appraise one current health policy issue. Provide a brief summary of your appraisal here. Then, perform a search to find ways that nurses have or could become involved in this policy issue through active participation on committees, boards, or task forces at the institutional, local, state, regional, national, and/or international levels. Give specific examples of ways you could advocate for nursing for this issue.
RUBRIC: 20 pts
Exceptional
One post written in response to fellow learners’ post between 100-150 words. Response is substantive insightful and contain at least one reference.
STUDENT’S POST:
Explore the critical healthcare policy issues affecting healthcare access, cost, and quality. Describe at least one issue that relates to each principle.
In health care delivery access, cost and quality are interrelated in many ways. These are the most important factors in health care delivery, which is ultimately the centerpiece in US health care (Shi, & Singh, 2019). For most of the years in the US employers and third-party payers were controlling the growth of health care payments. The ability of a person to receive health care service when needed is referred to as health care access (Shi, & Singh, 2019). One issue in the Us health care access is an out-of-pocket expense. An estimated under the Affordable Care Act (ACA), and allowed the uninsured rate low. Furthermore, the ACA was designed to expand coverage options and reduce high out-of-pocket spending for people without access to employer-based health insurance. However, most of the enrolled population ends up with high deductible plans. Americans also spend more out-of-pocket than any other country people. In health care delivery cost carry different meaning according to the viewpoint of the involved person (Shi, & Singh, 2019). The report of CDC (2016) stated that the health care spending in the US is $3.0 trillion, and it is predicted to be continuing to increase. According to expert opinion and statics, the fastest-growing component of the US economy is healthcare (Shi, & Singh, 2019). The hospitals and health plans are expected to publish their negotiated prices for consumers. The increased transparency will lead to more competition and reduced prices over time. Quality in health care referrer to the point of delivery or from the point of receiving population (Shi, & Singh, 2019). One of the lack of clinical quality is medical error. According to IOM (2004), 44000 to 98000 patients die due to medical error (Shi, & Singh, 2019).
How does the Affordable Care Act address each of these variables?
According to ACA, the main cost control is to Medicare payment cut to providers (Shi, & Singh, 2019). To control the cost regulatory bodies, constrain the supply side that is restrict reimbursement to providers. Managed care approach largely credited with a break on rising healthcare spending. The new payment model in the ACA uses a value-based model in which the reimbursement to the health care organization on quality measures. This type of program is designed to ensure that patients receive high-quality care (Smith, 2013). The ACA reforms have contributed to a slowdown in health care spending growth by paying the providers with their performance and it encouraged to improve quality care (Shi, & Singh, 2019). Access to healthcare increased under ACA the proportion of the US population without a regular source of care decreased 29.8% in 2013 to 26% in 2014(Kinney, 2017.). This change is more obvious among low-income people.
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Define health policy in the context of the US government. Expound on the scope and role of such. Critically appraise one current health policy issue. Provide a brief summary of your appraisal here. Then, perform a search to find ways that nurses have or could become involved in this policy issue through active participation on committees, boards, or task forces at the institutional, local, state, regional, national, and/or international levels. Give specific examples of ways you could advocate for nursing for this issue.
Healthcare policy involves the creation and implementation of laws, rules, and regulations for managing the nation’s healthcare system (Shi, & Singh, 2019). The healthcare system consists of services provided by medical professionals to diagnose, treat, and prevent mental and physical illness and injury. The United States primarily as a third-party payer system of healthcare, which means that a health insurance plan (the third party) reimburses doctors for the bulk of the cost of healthcare services provided to patients (ACA 2018). The nation used a mixed system of public and private insurance. The two major public programs are Medicaid (Links to an external site.) , for low-income people and individuals with disabilities, and Medicare (Links to an external site.) , for people 65 or older or younger people with certain disabilities or kidney disease. 48 percent of Americans are enrolled in private health insurance through their employer (Shi, & Singh, 2019). The remainder of insured people either purchase private insurance through the individual market or receive insurance through a different publicly funded program, like the military’s TRICARE.
NPS is the fastest-growing member of the primary care provider workforce and is the provider of preference for millions of Americans. Safeguarding a patient’s right to choose an NP as their health care provider and to have that care covered under their insurance plan is a key priority for AANP. This includes supporting the representation and implementation of insurance laws for direct credentialing and reimbursement of NPs, guaranteeing that reimbursement rates promote justifiable practices (AANP 2020) As states experiment with and deploy new models of care delivery and reimbursement, policy decisions must include NPs as primary care providers and leaders of Accountable Care Organizations, Patient-Centered Medical Homes, and other coordinated care initiatives (Johnson, 2016). Additionally, full, and open participation for NPs in value-based payment models, telehealth, and facility governance will be critical as the health care system shifts to promoting coordinated care. AANP further calls for policies that ensure fair, competitive, and level playing fields that support patient choice in providers, network adequacy, meaningful reporting measures, and sustainability.
References
American Association of Nurse Practitioners (AANP 2020) .StatePpolicy Priorities.. https://www.aanp.org/advocacy/state/2022-state-policy-priorities (Links to an external site.)
Care coordination for dually eligible Medicare-Medicaid Beneficiaries under the Affordable Care Act. (2018). The Affordable Care Act, 131-142. https://doi.org/10.4324/9780203722572-14 (Links to an external site.)
Health policy and economics: Strategic issues in health care management. (2017). https://doi.org/10.4324/9781315209975 (Links to an external site.)
Johnson, T. R. (2016). The Supreme Court Decision-Making Process. Oxford Research Encyclopedia of Politics. https://doi.org/10.1093/acrefore/9780190228637.013.98 (Links to an external site.)
Kinney, E. D. (2017.). The impact of the Affordable Care Act on the Medicare program. The Affordable Care Act and Medicare in Comparative Context, 305-321. https://doi.org/10.1017/cbo9781316275245.013 (Links to an external site.)
Shi, L., & Singh, D. A. (2019). Delivering Health care in America (7th ed.). Jones & Bartlett Publishers.
Smith, H. A. (2013). Prevention and US health care. An Introduction to Health Policy, 71-81. https://doi.org/10.1007/978-1-4614-7735-8_6 (Links to an external site.)