How DNP Prepared Leaders Can Promote Health Care Reforms

The Effects and Implications of Legislation on Health Care Reform

Although the health care network in the United States is heavily privatized and reforms have historically been in response to changes in demand and the need for greater efficiencies in the delivery of medical services, federal and state laws also exert a significant influence on health care reform. The purpose of this paper is to provide a review of the literature concerning the role of legislation in health care reform and its effect on health care costs. In addition, an analysis concerning how doctors of nursing practice-prepared leaders can develop strategies to advocate for just and ethical practices in healthcare policy and healthcare delivery systems. Finally, the paper provides a summary of the findings that emerged from the research in the conclusion.

The Role and Effect of Legislation in Health Care Reform

The health care system in the United States has historically been profit-driven, and the private sector’s responses to new pressures for innovation, delivering new services and developing cost-effective efficiencies have invariably been influenced by the invisible hand. These types of responses can be discerned, for example, in the manner in which tertiary health care facilities introduce new medical devices and interventions as research progresses. Nevertheless, it is clear that federal and state laws also have a profound influence on health care and any efforts to reform the manner in which it is delivered. Indeed, Forest and Stoltz (2022) emphasize that “legislation is a tool of public action in health policy” (p. 1). In some cases, legislation that is designed to implement beneficial reforms involves improvement in the information that is available to health care consumers and practitioners thereby making medical care more efficient (Cutler et al., 2019).

In other case, though, legislative reforms are more broad-based. For example, perhaps the most visible and influential legislation that has introduced reforms in the nation’s health care network is the Patient Protection and Affordable Care Act (ACA). For instance, according to Gable (2011), “The ACA set in motion a wide range of programs that substantially affected the health system in the United States and signifies a moderate but important regulatory shift in the role of the federal government in public health” (p. 340). This regulatory shift reflects the public sector’s legislative responses to increased demand for health care services, the recognition that more cost-effective strategies are required and the nation’s increasingly diverse and rapidly aging population.

While some of the provisions of the ACA address health care insurance and financing and therefore the costs of health care for American consumers, the legislation also establishes a number of initiatives that are intended to improve public health in general. As a result, Gable (2011) concludes that, “The ACA has the potential to produce extensive public health benefits across the United States population by improving access to health care and services and reducing costs” (p. 341). Notwithstanding the ongoing debate over specific provisions of the ACA and how they should be administered at the state and local levels, this legislation has already made a major impact on reducing the costs of health care and making services more accessible (Morone, 2020).

Although not all of the reforms that were implemented by the ACA have been well publicized and many American consumers and even health care practitioners may be unaware of their import, they have been highly effective in introducing the types of preventive care strategies that can help reduce future health care costs. For example, Morone (2020) points out that, “The ACA made a great many health systems reforms. Hospitals were given incentives to reduce infections, adopt electronic medical records, and reduce readmissions. The plan even included nutrition labeling requirements” (p. 759).

In sum, legislation has a direct effect on the cost and quality of health care in the United States in multiple ways, and new opportunities for reform are constantly being identified as research reveals more cost-effective, evidence-based interventions. This is not to say, of course, that simply passing a well-intentioned law will achieve its goals overnight, but it is to say that in a profit-drive health care environment, informed and timely legislation represents an important part of the nation’s health care network. Another important part of the health care network in the United States today is the growing cadre of doctors of nursing practice (DNP) who can serve as influential advocates for reform as discussed further below.

How DNP-Prepared Leaders Can Serve as Advocates for Health Care Reform

The consistent responses by the American public to those in need – both at home and abroad – is clear-cut evidence of their compassion and generosity. Indeed, Americans can be counted on to help out when the nation is in trouble, and the historical record is replete with examples of self-sacrifice in defense of the country. In other words, most American consumers and even policymakers want to help bring about changes that are in the nation’s best interest, especially when their own personal interests are also involved, but many simply do not know where to start.

This is where DNP-prepared leaders can step in and make a real difference by educating the public and lawmakers concerning what types of reforms are needed and why. This approach can be used for local citizen groups or town halls sponsored by lawmakers, but educating the public in general concerning the need for health care reform can assume any number of methods depending on the situation’s unique circumstances and the changes that are required. In this capacity, DNP-prepared practitioners can serve as the transformational leaders that meaningful reforms require. In this regard, Grace (2018) emphasizes that, “DNPs can, and ought to, be developed as transformational leaders. Transformational leadership is the ability to empower and motivate others toward a common vision or common goals” (p. 4).

Furthermore, educating the public concerning the ongoing need for reforms in the nation’s health care network is one of the standards of practice mandated by the American Association of Nurse Practitioners. In this regard, the standards specifically stipulate, in part, that, “In addition to their clinical role, NPs may provide a wide range of health care services, including health promotion; disease prevention; health education; and counseling to individuals, families, groups and communities” (Standards of Practice for Nurse Practitioners, 2023, para. 2). In addition, DNP-prepared leaders can also mobilize organizational and community resources to effect meaningful reforms at the local level (Hoyle & Johnson, 2015).