Assignment 1: The Cost of Health Care
Due Date: 12/09/2020
To evaluate an issue or policy, you must understand financing requirements and reimbursement mechanisms. This Assignment creates the opportunity for you to examine and articulate specifically how health care financing directly impacts the health care policy you have chosen to address in your Position Paper. Note: This is the same policy that was selected in your Week 1 Discussion.
Submit a 2-pages paper utilizing the selected policy from Week 1, analyzing the impact of financing and budgetary issues.
In addition to this week’s Resources, perform an informal literature search on the funding of your policy. Include at least two articles that discuss cost-effectiveness and cost controls pertaining to either your policy or nursing practices in general. Use these resources to respond to the following prompts:
• Describe how the policy is funded and annual costs of continuing the policy for the last year.
• Analyze any financial and budgetary efforts developed or being proposed to contain costs.
• Relate current cost-containment strategies, including regulations, managed care efforts, or other financial and budgetary initiatives.
• Describe how the financing of your policy impacts health outcomes and the role of the nurse in the workplace.
• Support your responses with evidence.
o In addition to the course resources, you must use at least two articles that discuss cost effectiveness and cost conrols.
o Support your ideas or those of others with references from the professional nursing literature.
Course Resources:
Required Readings
Mason, D. J., Dickson, E., McLemore, M., R., & Perez, G., A. (2021). Policy & politics in nursing and health care (8th ed.). St. Louis, MO: Elsevier.
• Chapter 16, “A Primer on Health Economics of Nursing and Health Policy” (pp. 134–140)
• Chapter 17, “Financing Health Care in the United States” (pp. 141–156)
• Chapter 18, “The Affordable Care Act: An Uncertain Future” (pp. 157–166)
• Chapter 56, “Nurse Staffing Ratios: Policy Options” (pp. 452–458)
Allegretto, S., & Michelson, D. (2014). Looking at variation through a quality lens. Healthcare financial management, 68(12), 42-49.
American Nurses Association. (2015b). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Retrieved from the Walden Library databases.
• Standard 16, “Resource Utilization” (pp. 82–83)
Kaiser Family Foundation. (2016). Health costs. Retrieved fromhttp://kff.org/health-costs/
Pope, J. E., Padula, E., & Wallace-Dooley, D. (2015). Improving ourselves for the sake of others: Our Baldrige journey. Frontiers of Health Services Management, 32(1), 3–16.
RAND Corporation. (n.d.). Health care financing. Retrieved April 4, 2016, from http://www.rand.org/topics/health-care-financing.html
Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2).
Watson, J. (2014). Young African American males: Barriers to access to health care. Journal of Human Behavior in the Social Environment, 24(8), 1004–1009
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Assignment 1: The Cost of Healthcare
Healthcare financing is a crucial aspect of the health systems as it facilitates the effective and substantial accomplishment of goals. In most nations, healthcare funding is acquired from a combination of private spending, governmental spending, and external aid. The finances cater for medications, human resources, and healthcare facilities to promote the provision of quality care and an improved patient satisfaction. One of the healthcare policies is the Meaningful Use (MU) that was implemented under the American Recovery and Reinvestment Act in the year 2009 to promote the use of Electronic Health Records (EHR) (Slight et al., 2016). This was to improve efficiency, coordination, and quality while engaging the patient in their health thereby reducing disparities. In 2018, the MU was renamed Medicare and Medicaid (Rouse, 2018). The program is run by the Centers for Medicare and Medicaid Services (CMS) which is a federal agency under the Department of Health and Human Services (HHS) branch. Precisely, the program’s financial requirements are catered for by 2 trust fund accounts that are run by the US Treasury; the Hospital (HI) and the Supplementary Medical Insurance (SMI) Trust Funds. Last year, the annual costs of continuing the policy were $796.2 billion from $740.7 billion in 2018.
To manage these costs, the government is focused on negotiating lower drug prices and setting provider fees. The government also regulates private insurance by introducing the Affordable Care Act (ACA) that controls the costs regarding marketplace coverage for the insurers (Mason et al., 2020). Another cost containment strategy is the mitigation of out-of-pocket fees for the involved beneficiaries in the program’s plans. There are also various attempts to contain pharmaceutical spending such as step therapy and prior authorization, the use of volume-based rebates to offset drug-prices, and the use of formularies for private health plans. By focusing on the implementation of regulations and managed care efforts, the government is in a position to monitor the rate of spending attributed to the policy. This is achieved through the establishment of a common ground for cost-control measures. For instance, the implementation of the ACA is geared towards managing the private insurance costs while setting the provider rates. This legislation is also structured around the negotiation of deep discounts for the program’s drugs.
The approach used for financing the Medicare and Medicaid policy positively impacts the role of nurses in the workplace and the health outcomes. In this case, the nurses are supplied with the necessary equipment to facilitate their increased efficiency, competence, and effectiveness while practicing their duties and responsibilities (Pope, Padula & Wallace-Dooley, 2015). These nurses also have a higher rate of job retention based on the motivation offered through compensation and the availability of favorable working environments. With a reliable platform to exercise their duties, the nurses are in a position to shrewdly monitor their patients while establishing good interpersonal relations. This creates a harmonious and well-managed environment whereby patients and their families can track their health records and monitor their progress with the sufficient supply of the required medications and treatments. The health outcomes are relatively improved based on the promoted quality of care (Kaiser Family Foundation, 2016). The outcomes are also influenced by the increased access to care, decreased mortality rates, and lack of care delay due to costs. Patients can also access care despite the financial distress facing the nation since the policy is responsive to economic downturns. As a result, the patient outcomes are influenced by a top-notch quality and a high level of satisfaction.
References
Kaiser Family Foundation. (2016). Health costs. Retrieved from: http://kff.org/health-costs/
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2020). Policy & Politics in Nursing and Health Care-E-Book. Elsevier Health Sciences. (pp. 141–156)
Pope, J. E., Padula, E., & Wallace-Dooley, D. (2015). Improving ourselves for the sake of others: Our Baldrige journey. Frontiers of Health Services Management, 32(1), 3–16.
Rouse, M. (2018). Meaningful Use. Healthcare assignment help. Retrieved from: https://searchhealthit.techtarget.com/definition/meaningful-use#:~:text=In%20the%20context%20of%20health,and%20between%20providers%20and%20patients.
Slight, S. P., Berner, E. S., Galanter, W., Huff, S., Lambert, B. L., Lannon, C., … & Payne, T. H. (2015). Meaningful use of electronic health records: experiences from the field and future opportunities. JMIR Medical Informatics, 3(3), e30. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704893/
