Healthcare Has Been Changing Over

¶ … healthcare has been changing over the last decade. The role of nurse practitioners has become ever more important. This paper conducts a policy analysis as a systematic investigation of alternative policy options, for the emerging nationalized healthcare plan and the increased use of nurse practitioners. It looks at the goals of nationalized healthcare's use of nurse practitioners and discusses to what extent this policy meets these goals. This paper begins with a detailing of the problem addressed by the policy and the goals and objectives of nationalized healthcare's increased use of nurse practitioners. Next, alternatives to meeting the increased needs of the health industry, other than through the use of nurse practitioners, is presented, along with an evaluation of the impact of these alternatives. Once an evaluation of alternatives is complete, these alternatives are then ranked in order of which would be most effective in meeting the needs of nationalized healthcare. Lastly, a discussion regarding monitoring the implemented policy is given.

Health Policy Analysis Paper

Introduction:

The face of healthcare has been changing over the last decade. The role of nurse practitioners has become ever more important. This paper conducts a policy analysis as a systematic investigation of alternative policy options, for the emerging nationalized healthcare plan and the increased use of nurse practitioners. It looks at the goals of nationalized healthcare's use of nurse practitioners and discusses to what extent this policy meets these goals. This paper begins with a detailing of the problem addressed by the policy and the goals and objectives of nationalized healthcare's increased use of nurse practitioners. Next, alternatives to meeting the increased needs of the health industry, other than through the use of nurse practitioners, is presented, along with an evaluation of the impact of these alternatives. Once an evaluation of alternatives is complete, these alternatives are then ranked in order of which would be most effective in meeting the needs of nationalized healthcare. Lastly, a discussion regarding monitoring the implemented policy is given.

Nationalized Healthcare Definition and Challenges:

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama, on March 23rd, 2010. This historic piece of health care reform legislation is scheduled for implementation over a four-year period. The legislation was created to "ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs" ("The Patient Protection," n.d.). There are nine primary components for this reform. These include: affordable health care for Americans, role of public programs, improved quality and efficiency of healthcare, improving public health and chronic disease prevention, healthcare workforce, program transparency and integrity, increased access to medical therapies, community living assistance, and revenue provisions. The problem this piece of legislation hopes to address is the estimated 45 to 75 million of Americans who are uninsured and the additional 50 million who are under-insured ("The United States," 2010)

Evaluation Criteria

The evaluation criteria to determine the effectiveness of this policy must include a variety of facets. First, there is the obvious quantitative evaluation method in determining how many Americans are uninsured or under-insured after the plan is fully implemented. It is estimated that the policy will provide coverage to more than 94% of Americans ("The Patient Protection," n.d.). Although serving these Americans is a primary goal of the Act, whether or not all of the people will be served is yet to be seen and will need to be monitored. In addition, the quality and efficacy of healthcare is another primary concern of this policy.

To monitor this, other statistics will need to be monitored, such as the level of care patients are receiving. Has this level risen with the implementation of the new policy? Are patients not only receiving care, but are they receiving appropriate care? Is this care being received in a timely manner? How the quality and timeliness of care for non-Americans living in this country will also need to be tracked and evaluated. All of these facets will need to be monitored to determine if the goals of the policy are being met.

Lastly, the financial costs of the policy will need to be monitored and evaluated. Proponents of the bill insisted that the PPACA is under the $900 billion limit that President Obama set. Much of this cost is supposed to come from additional taxes on certain medical devices and other consumer goods and services. In addition, some of the cost will be offset by employers who are penalized under the plan for not providing insurance, as well as penalties assessed to individuals who choose not to have insurance, forcing Americans into insurance coverage submission through fiscal blackmail. Although policy proponents estimate that this will positively impact the National deficit, only after full implementation will this be determined ("The Patient Protection," n.d.).

Possible Alternatives and the Impact of These Alternatives:

One thing is certain, with the passage of this historic piece of legislation will come an increased need for healthcare professionals as tens of millions have new access to no- and low-cost medical services. Meeting this increased demand can be found with several alternatives. As it stands currently, one of the most likely alternatives in meeting this demand is an increased reliance on nurse practitioners for the providing of medical care to patients. This is clearly the intent of the Act, with increased focus on education and training for nurses in areas including: geriatrics, chronic case management, long-term care, psychology, pharmacy, social work, and more. Nurse practitioners will be a critical part of community-based care transitions programs and other new programs, as well as primary care and general surgery services ("Public Law," 2010).

The impact of this alternative is that more healthcare services can be performed without doctors. Nurses and nurse practitioners will have more responsibilities and be able to provide a greater range of services. This will, however, increase the need for nursing professionals, to meet this demand. In addition, nursing education will need to be expanded to ensure the nursing professionals have the skills needed to perform these services. The current nursing curriculum and licensing procedures will need to be altered to accommodate these new duties.

A second alternative to meet this increasing healthcare need is to decrease the educational requirements for doctors. This would result in an increased number of doctors able to serve patients right away. This would also result in a quicker licensing of doctors due to a shorter educational experience. This reduced educational demand may also attract a greater number of students to the profession, as the long process is often one of the deterrents students face in considering whether or not to become a doctor. Of course, despite the likely increase in number of doctors entering the industry, this reduced educational alternative may negatively impact the level of service these doctors deliver, once they're interacting with patients.

A third alternative is to offer reduced cost (or even free) education for students wishing to become doctors. According to the American Medical, the average educational debt of indebted graduates of the class of 2009 is $156,456. Eighty-seven percent of graduates have outstanding student loans upon graduating medical school. Fifty-eight percent of these students have debt of $150,000 or more. Seventy-nine percent of medical school graduates have debt of at least $100,000 ("Medical student debt," 2011). Reducing the cost of medical school through tuition caps, tax deductions for loan interest, increased grants and scholarships, or even new programs that combine free or reduced cost medical school education with public service programs that would place these new doctors in government run medical facilities for a specified number of years, much like military education and service now, would likely result in more students pursuing a medical career. However, the cost of such a program would be a significant concern.

Lastly, a possible alternative to meeting the increased demand for medical professionals, due to the Act, is to make rules for foreign doctors wanting to work in America less strict. Reciprocity with countries for licensing, such as India, and actively seeking recruiting doctors from foreign countries to come to the United States, may help meet the needs of tens of millions of new patients entering the healthcare system.

Comparison and Ranking of Alternatives

The least likely to be an effective and efficient means of meeting the increased need for medical professionals, thanks to the new passed healthcare legislation, is a reduction in educational requirements for doctors. Although this would turn out doctors faster, by decreasing the number of years they have to spend in school and/or training, the result would be less educated and less experienced doctors. The benefit of possibly encouraging more students to pursue medicine as a career is far outweighed by the risks of less educated doctors in the field, possibly providing sub-standard care, especially in life and death situations. Of all of the alternatives, this is the option that has the greatest risks to patients and results in the lowest amount of likely increase in the number of doctors entering the field.

Reduced costs for medical education would be the second to last alternative that would be likely to be effective. First, reducing the costs of medical eduction, through tax incentives and tuition caps, may make the medical field more attractive to some students; however, even with these in place, the costs would still be so significant that many potential future doctors would be still turned off from the profession. In contrast, free medical education would likely be very effective in recruiting students to pursue the medical profession. This would likely be especially attractive to good students who weren't good enough to receive significant scholarship money to help offset their education. However, this would be the most expensive alternative to implement for the United States. This cost could be offset by the service these doctors give, in exchange, for government-run medical facilities, but the infrastructure alone to this type of innovative plan would be astronomical.

Loosening restrictions for foreign doctors would be the next best alternative in the implementation of the PPACA and the increased need for healthcare professionals. There are a variety of countries that are providing world-class medical education to their students. The allure of coming to America would also likely be attractive to a wide variety of foreign doctors. However, there is a concern, as with reducing the educational requirements, that these doctors may not be up to the standards of American doctors. In addition, this is the only alternative that has national security concerns attached to it. Recruiting foreign doctors could be an avenue for terrorists, for this reason strict background checks and other national security procedures would have to be put into place. Logistically, ensuring the foreign education is fairly comparable, it would be difficult, but not impossible, and would meet the growing patient demand.