Posted: January 16th, 2023
Discussion: Organizational Policies and Practices to Support Healthcare Issues
The cost of healthcare in the US has continued to elicit concerns and debates towards healthcare system reforms. The ensuing debates have culminated into unanimity for an affordable and quality healthcare system. The realization of policy reforms towards this direction is a lengthy and complex process characterized by competing demands that require careful consideration due to subverting influence they may have on the policy process. Oliver (2006) terms policy processes as being political, characterized by power, control, and influence which determine the translation of evidence-based solutions into policy actions. As the process involves multiple stakeholders, multiple interests come into play. Based on how they are affected, they will exert influence and power in support of or against the policy which could ultimately result in abandonment of a policy or its fast-tracking. Political institutions also play a crucial role Discussion: Organizational Policies and Practices to Support Healthcare Issues. When there is political good will from federal and state governments, policy development process gunner support and is faster. Further, the financial affordability of a policy determines its potential to sail through as it involves fiscal ability of government to take additional responsibilities (Oliver, 2006).
A healthcare system is characterized by multiple stakeholders whose interest and power on a policy significantly influence policy development process and outcome. Patients are keen on accessing affordable quality healthcare services while hospitals, care providers, pharmaceuticals, and drug manufacturers struggle to balance between offering the best care at affordable costs while meeting their business interests. Balancing such needs put policy developers at a dilemma. The Affordable Care Act for instance has elicited different reactions from different stakeholders depending on who benefits and who loses. Among the critics has been the insurance industry whose business has been severely affected with 37.9% decline in their application for Medicaid and Medicare Services enrollment. Discussion: Organizational Policies and Practices to Support Healthcare Issues. Some have had to close their businesses while others have had to opt for mergers. This has created an uncompetitive environment resulting in increased premium rates not favorable for patients (Patterson, 2018). On the other hand, are the pharmaceutical manufacturers that have been blamed for increasing costs of healthcare costs. Campbell (2019), noted that prescription drugs in US costed 56% less in developed countries resulting in 8% of Americans attaining their drugs from Canada while others have had to cut on their prescriptions which have been fatal. To address these concerns, a single-payer system is proposed which will replace private insurers as well as promote price negotiations with drug manufacturers reducing cost of healthcare and of drugs respectively. According to Himmelstein and Woolhandler (2020), this model would also save doctors the expense and agony of contract negotiations and billing bureaucracies while reducing hospitals’ administrative costs related to billing estimated at $ 401 billion as at 2017. Discussion: Organizational Policies and Practices to Support Healthcare Issues.
Political institutions are the regulators and administrators of health policies and therefore, alignment of policy reform proposes to political agenda facilitates buy in, ownership and support. For example, the need for value-based care has received unmatched support from US Department of Health and Human Services as well as from five State Governors of Ohio, Nevada, Colorado, Alaska and Pennsylvania and has thus been widely adopted with several strategies towards its implementation developed (Karapiperis, 2018). As proposed, the value-based model offers the current administration opportunity to offer affordable healthcare that is quality-based and aligned to the current price and quality transparency (HHS, 2019). Moreover, it facilitates healthcare organizations to be more cost-effective and affordable hence being more competitive. Discussion: Organizational Policies and Practices to Support Healthcare Issues
Anticipated costs of policy implementation often determine the successful development of a policy. The cost considerations include cost justification against benefits, opportunity costs, and availability of finances. For instance, the current government healthcare expenditure particularly Medicaid and Medicare Services has been heavily criticized. The basis of criticism has been among others increased cost of healthcare expenditure and failure for such investments to translate to better health outcomes, with US healthcare outcomes lagging behind those of comparable countries (Karapiperis, 2018). Shift to single-payer system is anticipated to result in $600 in cost savings (Himmelstein and Woolhandler, 2020).
Campbell, K. (2019, August 6). Trump Administration’s Plan to Lower Healthcare Costs. Retrieved from MedPageToday: https://www.medpagetoday.com/blogs/campbells-scoop/81446
HHS. (2019, November 15). Trump Administration Announces Historic Price Transparency Requirements to Increase Competition and Lower Healthcare Costs for All Americans. Retrieved from HHS: https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html Discussion: Organizational Policies and Practices to Support Healthcare Issues
Himmelstein, D., & Woolhandler, S. (2020). Single-Payer Reform: Heed the Evidence, Not the Soothsayers. American Journal of Public Health.
Karapiperis, D. (2018). A Brief Exploration of Rising Health Care Costs. The Centre for Insurance Policy and Research.
Oliver, T. (2006). The Politics of Public Health Policy. Annual Review Public Health, 175-233.
Patterson, L. (2018). The Pricing Impact of Decreasing Competitiveness of the Health Insurance Market. University of Tennessee Honors Thesis Projects. Retrieved from https://trace.tennessee.edu/utk_chanhonoproj/2202
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations. Discussion: Organizational Policies and Practices to Support Healthcare Issues
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care? Discussion: Organizational Policies and Practices to Support Healthcare Issues
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.
Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.
Respond to at least two of your colleagues on two different days by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described. Discussion: Organizational Policies and Practices to Support Healthcare Issues
I enjoyed reading your post and likewise believe that health care in the United States presents itself as a rather confusing conundrum. On the one hand, you are told you must have insurance of be fined at the end of each year, but on the other hand many individuals say they can’t afford the required payments each month for insurance coverage Discussion: Organizational Policies and Practices to Support Healthcare Issues. So, the question becomes how to provide healthcare for everyone at an equitable rate, but even more so, how do you reach the uninsured? For example, something I see in my daily practice as an ER nurse is uninsured individuals coming into the ER because they couldn’t pay the out-of-pocket cost a primary care physician would charge to see them. These individuals are not denied health care outright, but the offices require all or most of a visit cost upfront for uninsured patients as a way to protect themselves, but oftentimes an individual cannot afford the out-of-pocket expensive of even a routine or simple health care visit. So, they leave the office and drive a few miles to the ER to be seen, the bill is then paid over time or is not paid at all, and ultimately this does not benefit the individual or the health care system. One specific example, my daughter had to see a podiatrist for custom orthotics- normal office visit, meet the doctor, x-ray her feet, make a mold for her feet, go over exercises and stretches for her feet, and then out the door. The breakdown of her medical bill was pretty outlandish I feel like. Discussion: Organizational Policies and Practices to Support Healthcare Issues. Just the billing to her insurance for the visit- none of the casting and x-rays, just the visit to see the podiatrist was $2,500. Yes, $2,500. Now again, insurance will pay the bulk of that fee, but the point is when you broke down the billing cost for each thing the podiatrist charged for, her 1-hour doctor visit equated to over $4,000. We will have to pay a few hundred out of that total, but what if she didn’t have insurance? What then? If a person in uninsured they more than likely do not have the funds for insurance, but may not qualify for Medicare, so how do they receive treatment? Could you afford a $4,000 out-of-pocket office visit for a visit to the podiatrist, and more importantly, even if you could would you want to? I feel like for most people the answer is no (if not to the first question then most certainly the last). So, then what happens? You don’t go to the appointment, you don’t get the custom orthotics, your feet give you more and more problems, maybe you are in pain all of the time, maybe you can’t work because it becomes debilitating, maybe you just can’t do things like run or walk for exercise- things that are good for your body. The point is the way uninsured individuals have to interact with the healthcare system is a problem, and is a relatively silent problem since their voices are often overlooked and not considered- it’s easy to forget and leave out those whom you don’t see receiving medical care. Discussion: Organizational Policies and Practices to Support Healthcare Issues.
One step in the right direction was President Obama’s Affordable Care Act, which was signed into existence in 2010 right are the peak of the Great Recession (Blumenthal, Abrams, & Nuzum, 2015). The Affordable Care Act sought to lower medical costs for individuals and provided a longer time in which children could be carried on parental insurance, letting many young adults, recent college graduates, and those working their way through various career fields a few additional years to be financially secure and to cover themselves for insurance. Remarkably, in an analysis of the Affordable Care Act Blumenthal, Abrams, and Nuzum (2015) demonstrate the ACA creating a decline in the need for federal funding to cover health-expenditures, specifically demonstrating federal funding for health care at an all-time low “3.2% annually as compared with 5.6% annually over the previous 10 years” (p. 2456). Discussion: Organizational Policies and Practices to Support Healthcare Issues.
Another potential to limit the cost of these visits is to work with more and more remote technologies and to do simple things such as paramedicine and have licensed medical workers go to patients, take bloodwork, conduct a physical, and act as an intermediary for physicians. The technology exists, and costs could be lessened with the use of current medical professionals and expertise, without necessarily accruing a large medical bill for an office visit (Laureate Education Producer, 2012 [Video File]).
Bulmenthal, D,. Abrams, M., & Nuzum, R. (2015). The affordable care act at 5 years. The New England Journal of Medicare, 372(25), 2451-2458.
Laureate Education (Producer). (2012). Ethical, Moral, and Legal Leadership [Video file].
Baltimore, MD: Author. Discussion: Organizational Policies and Practices to Support Healthcare Issues.
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