DNP Leadership Roles in Patient Outcomes and Healthcare Change

Introduction

Today, the United States spends more taxpayer money on healthcare services than virtually any other industrialized country in the world, yet Americans still pay more out-of-pocket expenses and receive fewer physician visits per year compared to nations that spend less. Moreover, the demand for already scarce healthcare services is expected to increase alongside the rapid growth of the elderly demographic, and these demands will likely continue to expand as the baby boomer generation retires in greater numbers and lives longer than past generations.

Against this backdrop, it is worth examining how and why the United States stands alone among dozens of other countries — many of them still developing — in its lack of universal healthcare. The purpose of this paper is to provide a review of the relevant literature concerning the provision of universal healthcare services in Canada, including its health outcomes and how they compare to those in the U.S. In addition, an assessment of whether universal healthcare should be a concept supported by a Doctor of Nursing Practice (DNP) is provided, followed by results from a healthcare quiz and an analysis of its implications for the U.S. healthcare system. Finally, a review of selected articles and the DNP's leadership role in promoting optimal healthcare outcomes is followed by a summary of the research findings in the conclusion.

Universal Healthcare in Canada and Comparisons to the U.S.

Today, the United States is the only major industrialized nation that treats access to healthcare services as a privilege rather than a fundamental human right. One country routinely cited as superior to the U.S. in terms of healthcare coverage is Canada, which has offered some level of government-subsidized healthcare services to all of its population since the mid-20th century (The birth of Canadian Medicare, 2018). This trend was reinforced by the passage of the Canada Health Act of 1984, which transformed the disparate components of the provincial healthcare system into a true nationwide resource that is currently free to all Canadian consumers at the point of care (Martin & Miller, 2018).

Although the universal healthcare coverage offered in Canada is a laudable objective, the services provided are limited compared to other countries, including the United States, and lengthy wait times for elective care are the norm (Martin & Miller, 2018). In addition, access to universal healthcare in Canada is restricted by geographic proximity to available clinicians, and access for the country's large rural population — including, most especially, its diverse indigenous peoples — is especially limited. In this regard, Martin and Miller (2018) emphasize that "profound health inequities experienced by Indigenous populations and some vulnerable groups require coordinated action on the social determinants of health if these inequities are to be effectively addressed" (p. 1719). Furthermore, the healthcare system in Canada has limited access to new medical technologies (Roy, 2015).

Notwithstanding these constraints, the outcomes achieved by Canada's universal healthcare system are enviable, with an infant mortality rate ranked 180th lowest and the 21st highest longevity rate in the world (Canadian people, 2018). Nevertheless, Canadian healthcare consumers still suffer from some of the same health problems as their U.S. counterparts, including obesity levels ranked 26th highest in the world (Canadian people, 2018). In order to improve these suboptimal outcomes, Martin and Miller (2018) advise that "expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades" (p. 1720). Taken together, it is reasonable to conclude that the Canadian universal healthcare system remains a work in progress, but the treatment of healthcare access as a right rather than a privilege is a concept that all DNPs should support for the United States, given its potential to extend lifespans and improve quality of life for consumers.

Commonwealth Fund International Healthcare Quiz Results

The Commonwealth Fund provides an international review of healthcare systems. The results of the associated quiz based on the International Profiles of Health Care Systems, 2014 report are presented below, followed by a summary of the knowledge gained and how it should be applied to the U.S. healthcare system.

Question 1: In which two countries are adults least likely to get a doctor's appointment for the same or next day when they need care?
Selected answer: Canada and the U.S. — Correct. Only 48 percent of people under 65 in the U.S. and 41 percent of people in Canada are able to get a same- or next-day appointment. However, U.S. residents do, on average, have relatively fast access to specialists.

Question 2: About how much does the U.S. spend annually on healthcare per person?
Selected answer: More than $8,000 — Correct. The U.S. spends $8,745 per person on healthcare annually, more than any other nation and $5,000 more than Japan, a low-spending country. Despite this high rate of spending, U.S. health outcomes are not superior.

Question 3: In which countries do people have the longest life expectancy?
Selected answer: Japan and Switzerland — Correct. Japan and Switzerland have the longest life expectancy at 83 years. In the U.S., it is 79.

Question 4: What country other than the U.S. has a large uninsured population?
Selected answer: Neither — Correct. No other industrialized country has a large uninsured population. Germany, England, and all other high-income countries have much smaller uninsured populations than the U.S.

Question 5: In which countries are most hospitals publicly owned?
Selected answer: Denmark and New Zealand — Partly correct. The majority of hospitals are publicly owned in New Zealand, but in the Netherlands the majority are privately held. Australia, England, France, Italy, Norway, and Sweden are other countries where the majority of hospitals are publicly owned.

Question 6: Health spending growth has slowed in the U.S. in recent years. How has health spending been growing in other industrialized countries?
Selected answer: Faster than in the U.S. — Incorrect. Health spending is growing at about the same rate in other industrialized countries as it is in the U.S. However, the U.S. still spends much more on healthcare — 16.9 percent of GDP compared to the median rate of 9.3 percent of GDP for all industrialized countries.

Question 7: About how much more, on average, does an orthopedic surgeon earn in the U.S. than in France?
Selected answer: $114,000 more — Incorrect. The correct figure is $288,000 more. In the U.S., orthopedic surgeons on average earn $442,450, while in France they earn $154,380.

Question 8: Where do adults age 65 and older have out-of-pocket healthcare costs on par with those paid by older adults in the U.S.?
Selected answer: The U.K. — Incorrect. In Germany, only 7 percent of older adults spent $2,000 or more on healthcare. Twenty-two percent of older adults in Switzerland and 21 percent in the U.S. spend that much, making Switzerland the correct answer.

Question 9: In which areas of care does the U.S. perform well relative to other countries?
Selected answer: All of the above — Correct. The U.S. does well in all of these areas. Fifty-eight percent of chronically ill older adults in the U.S. reported they had discussed their treatment goals with their doctor and had clear instructions about when to seek further care. Eighty-three percent of U.S. respondents reported they had a treatment plan they could carry out in their everyday lives — one of the highest rates among the nations surveyed. And 86 percent of older adults said they had enough time with their doctors.

Question 10: Do Americans go to the doctor more or less frequently than people in most other industrialized countries?
Selected answer: More often — Incorrect. Americans tend to go to the doctor less frequently than people in other high-income countries. There are about four visits per person in the U.S. annually, compared to almost eight in Canada.

Despite several incorrect answers, the quiz ranked the total responses as reflecting a "Seasoned Traveler" who "may not be able to lead the tour group yet, but you know your way around a health system." The overarching issues that emerged were the perplexing facts that, while the U.S. spends nearly twice as much as other industrialized countries on healthcare, the nation still lags behind many of them in terms of accessibility and outcomes achieved. While it is clear that additional resources are needed to provide better healthcare coverage for U.S. citizens, other factors — including preventive care services that reduce the need for long-term acute care — must also be addressed.

Conclusion

The research was consistent in underscoring the increasing importance of the advanced practice nursing role in healthcare settings of all types and sizes. In addition, the research showed that simply spending more money on healthcare disparities is not always the optimal solution, as evidenced by the profound differences in outcomes being achieved in the U.S. compared to other industrialized countries that offer universal healthcare services. Finally, it is reasonable to conclude that current barriers to the expanded role of advanced practice nurses will continue to erode in the face of growing demand and dwindling budgets.

References

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Roy, A. (2015, January 27). Conservative think tank: 10 countries with universal health care have freer economies than the U.S. Forbes. Retrieved from https://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think-tank-10-countries-with-universal-health-care-are-economically-freer-than-the-u-s/.

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