Access to Health Services

Access to Health Services is one of the main objectives of Healthy People 2020. As the Office of Disease Prevention and Health Promotion (ODPHP, 2017) notes, acces to quality health care services is essential for sustaining and promoting healthy communities, preventing the spread of disease, and eliminating unnecessary disabilities and deaths for Amerircans. While insurance coverage has been expanded thanks to the ACA (Somanader, 2016), timeliness of care and access to health services are still issues that keep patients from obtaining the quality care they need. As the IOM (2012) has stated, APRNs need to be able to practice to the full extent of their abilities and knowledge so that more patients can be treated and more quality care can be provided. As there continues to be a lack of care providers in the industry, the role that APRNs can play is considerable. The problem in the state of Florida is that nurses are still restricted by state laws when it comes to practicing to the fullest extent possible. Federal and state laws restrict the practice of nurse practitioners. APRNs must practice under the supervision of a physician. They also do not have full prescription authority. APRNs also have restrictions on insurance reimbursement. There are several proposals in the House and Senate that can advance to role of the APRN to help meet the rise of primary care providers.  This paper will discuss the policy issues related to access to health services and how the current Health Care Access Bill winding its way through Congress may lead to a policy change that helps the industry meet the Healthy People 2020 objective.
Currently there is a lack of available services for patients seeking preventive care and treatment, according to ODPHP (2017). Having a usual source of care and continuity of care is very important for patients, as De Maeseneer, Prins, Gosset et al. (2003) show in their research. According to the CDC (2016), from 2014-2015, there were 17.3% of people between the ages of 18 and 64 without a usual source of care. This percentage increased the younger the population got. For children, more than 10% of them had no health care visits to an office or clinic for an entire year from 2014-2015 (CDC, 2016). The problem is that there are too few providers able to make diagnoses and provide prescriptions or treatments because of state and federal laws that restrict the ability of APRNs to exercise to their fullest ability.
The entire point of having APRNs was so that they could tend to patients in the same manner as physicians—yet legislators continue to be behind the curve and not realize the opportunity that they are letting slip by because of old laws and policies that are still on the books. As Szabo (2014) reports, the incidence and prevalence of untreated patients is very high: Nearly 40% of all adults with severe mental illness like schizophrenia or bipolar disorder fail to receive the care and treatment they need. That percentage is even higher for adults with moderate mental illness. The cost of turning so many patients away is felt in numerous ways: patients suffering from mental illness who do not receive care typically end up on the streets or in jail cells, adding to the burden of tax payers and city managers who must find ways to deal with individuals who really need medical treatment. As many of these patients end up in prison, it is worth noting that the cost of incarceration comes in at $60,000 a year (Szabo, 2014). That is tax payer money that could be used to build roads, schools, and update infrastructure—if only there were enough care givers to treat patients like this. APRNs could help—but they are not permitted in states like Florida because of outdated policies.
The health care policy that is currently going through Congress is the CS/HB 7011: Health Care Access Bill, which would allow independent APRNs to practice advanced and specialized nursing without the need of a physician there to supervicse them. It would authorize Florida-licensed health care providers to utilize new technology like telehealth to provide quality care as well. In other words, the bill would help new policy to effectively enable APRNs do what they were always intended to do: alleviate the crisis of lack of access to care currently felt throughout the industry.
Legislators involved in the policy development and its dissemination include Rep. Cary Pigman and Rep. Cord Byrd who sponsored the bill in the House. The bill has, however, run up against opposition in the Senate unfortunately. The bill would be a great thing for the community as it would enable patients to have more options in terms of receiving quality care as it would allow APRNs to treat more people. Reps. Pigman and Byrd of the House Health Quality Subcommittee recognize this and have promoted the bill to help get new policy implemented in Florida.
APRNs can assist in this policy change by calling on the community to get in touch with their Senators and Representatives to get behind this bill and implement a change that will make a difference. APRNs have a strong voice and if they unite themselves together they can effect real change. The American Association of Nurse Practitioners (AANP) for example has been able to make an impact on the health care industry over the years and APRNs in Florida could certainly do the same by organizing. By working together to support the bill and to call on the community to reach out to their Congressman to support the bill, policy can be effected that is good for all.
The policy would influence clinical practice by expanding the role of APRNs in the health care industry in Florida so that more patients can have access to treatment by APRNs instead of having to rely on physicians to always oversee them in every case. By broadening the manner in which care can be delivered, interprofessional teams can ensure a more coordinated and comprehensive care for the population of Florida as a result of a sweeping new access to care. Interprofessional teams could respond to the needs of patients with greater continuity and quality than before because APRNs would finally be free to practice as they were trained and as they are qualified to practice. As Hain and Fleck (2014) point out, the barriers to receiving quality care are rooted in this problem of poor access to care—and that can change immediately the policy is altered. If the bill promoted by Reps. Byrd and Pigman would get passed, the community of Florida would benefit substantially.
In conclusion, Healthy People 2020 shows that access to quality health care services is one of the most important issues that needs to be addressed in the American health care industry. The problem is that there are not enough providers offering preventive services and/or treatments for patients. As a result, too many children are going without care, too many adults are not receiving treatment, and too many mentally ill patients are ending up on the streets or in jail—which only adds to the burden of tax payers. By promoting a bill like that sponsored by Pigman and Byrd in Florida, APRNs could help to alleviate the problem that the community in Florida is facing. By changing the restrictive policy that currently exists, legislators would enable greater access to care through APRNs. APRNs would be free to provide the kind of services they are fully capable of providing and that they have indeed been trained to provide. This policy would help all stakeholders in health care.

References
CDC. (2016). Health United States Report. Retrieved from
https://www.cdc.gov/nchs/data/hus/hus16.pdf#062
De Maeseneer, J.M., De Prins, L., Gosset, C., et al. (2003). Provider continuity in family
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Hain, D., Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare
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IOM. (2012). The future of nursing. Retrieved from
http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
ODPHP. (2017). Access to health services. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
Somanader, T. (2016). A look at six years of the affordable care act. Retrieved from
https://obamawhitehouse.archives.gov/blog/2016/03/23/look-six-years-affordable-care-act
Szabo, L. (2014). Cost of not caring: Nowhere to go. Retrieved from
https://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/