Healthcare Policy and Health

¶ … honored to meet a delegation of nurses from ten different countries, because I feel we have a lot to learn from each other in terms of different philosophies of nursing. At the same time, we are all shifting more to evidence-based practice, which transcends linguistic and cultural differences. One of the most difficult things to explain would be access to care, as the United States has the top equipment and doctors in the world but the highest cost of care, too. I would try to explain that although many Americans support the Affordable Care concept, and would even like to see Obamacare taken a step further to improve access and quality of care, many citizens remain uninformed and believe that the current profit-driven model is acceptable.

Most problems can be framed as a policy issue, because policy has real implications for day-to-day practice. Longest's policy framework demonstrates how American policymaking is a "continuous, highly dynamic cycle," containing three main phases including policy formulation, implementation, and modification (Mason, Gardner, Outlaw & O'Brady, 2015, p. 65). For example, we are currently facing a staff shortage that could be remedied by policy. Therefore, we are at the policy formulation stage.

The policy and advocacy component of the American Nurses Association offers a treasure trove of information helpful to nurses who wish to become more effective leaders. We are the largest group of health professionals, according to the ANA (2016), which is why we need to recognize and wield our power effectively. One of the ways we can serve as advocates would be to learn how to write more effective letters to editors, leaders, and politicians. In the tips for writing letters, we learn that letters to the editor should clearly identify the speaker and concisely address the issue as follows.

Dear Editor,

I am thrilled to find out that a new clinic for geriatric ambulatory care has opened in our community. As a nurse working for the local hospital, I understand the need for improved care services for seniors. Many seniors enter the emergency room with non-emergencies, burdening the hospital unnecessarily, and those patients can be diverted to the ambulatory care clinic where they can receive the specialized treatment that they need. I am writing to express my sincere appreciation to the city council and mayor for their support.

My topic of interest in geriatrics has yielded several databases, some with tremendous datasets like the Health and Retirement Study with more than 26,000 samples. Data is collected on information ranging from income and pension plans to health care expenditures. The University of Michigan's Health and Retirement study offers graphics, charts, and other means of visualizing data, which is collected every two years. With a study this large, there are few methodological weaknesses in terms of external validity. Reports include issues from multiple subject areas like severe depression, which is evident in about twenty percent of all persons over the age of 85 (Health and Retirement Study).

Increasing healthcare costs are due to a number of factors, many of which are complex and more within the province of economics than healthcare such as inflation and labor costs. However, there is a lot of wastefulness and redundancy in the system, which is profit-driven and therefore based on the motivation to sell products and services that may not be entirely necessary. Nursing has been impacted by efforts to contain costs, seen in our staff shortages in particular.

Healthy People 2020 goals include reducing health disparities, with a focus on identifying the "determinants of health." Those determinants include access to education, which is linked to health, as is access to nutritious food, good housing that is affordable, clean water and air, and health insurance. Many disparity measures focusing primarily on ethnicity fail to take into account economic issues too. This is not to say that ethnic and cultural factors are not important in improving overall wellbeing, as nurses are becoming more culturally competent. In terms of maternal, infant, and child health, Healthy People 2020 acknowledges that disparities exist and are largely due to affordability and accessibility. The disparities can be minimized through effective healthcare policy.

H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015 is pending in the U.S. House of Representatives. Using the diagram (Figure 43-1), and although it is difficult to know exactly where HR 2 stands now, it may be in the authorization stage, in which case nurses no longer need to influence the outcome. After all, the bill is to reauthorize previous legislation. If, however, the bill is in earlier stages of deliberation, then we could work closely with our state's representatives in Congress to influence their decision-making based on evidence-based practice related to the bill and its intended outcomes.

The American government was deliberately structured to ensure checks and balances between the legislative, executive, and judicial branches. In terms of the Affordable Care Act, it was introduced into first the House and then the Senate, as all bills begin in the legislative branch. Then, the President signed the bill into law, marking the role of the executive branch. Challenges to the Affordable Care Act were later brought before the Supreme Court, introducing the judicial branch -- which does not routinely get involved in lawmaking but only when there may be a conflict between the bill and Constitutional law. The concept of federalism is integral to the Affordable Care Act, as it creates a federal mandate for insurance coverage, something that had previously been left up to the states to decide. The American government has always attempted to balance the interests of a strong federal government with the drawbacks thereof, deferring to states for several decisions and issues.

After taking this class, I feel more empowered as a nurse because I understand our role as advocates for patients and fellow nurses, as well as for the nursing profession in general. I also realize that my role as a nurse might include policymaking in the future, as healthcare policy should be developed by people who know the industry and are concerned with patient rights. Speaking truth to power refers to advocacy and human rights issues. It means taking back power, ensuring that all citizens understand their rights and have powerful advocates who can fight for those rights. Speaking truth to power entails speaking genuinely, avoiding rhetorical pitfalls and maintaining earnest discourse. After taking this class, I am certainly better informed, empowered, and prepared to speak truth to power.

An interview with a senior manager at our healthcare institution revealed some interesting perspectives on aging in America. Administrators are often under pressure to monetize, and can sometimes forget to retain a patient-focused perspective. Instead of focusing only on costs and how to improve profitability, our organization is attempting to find ways of encouraging more ethical treatment of both nurses and patients by collaborating with other private and public stakeholders in the community to create a system for comprehensive care delivery to seniors.