Nursing Shortage Assignment Paper

 

Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.

Introduction

The contemporary U.S. Health Care System is considered to be distinctly sophisticated, unequal, characterized with uneven quality and costly (Joel, 2017). Originally private, the current health care delivery system in the United States of America is a complex mix of both public and private partnerships following a series of reforms aimed at addressing persistent market failures in the financing, access and delivery of superior quality, safe and affordable care to the majority of people, especially vulnerable populations (Salmond & Echevarria, 2017). Although major legislative and institutional reforms over the last two decades have contributed to enhanced coverage and access to health care, these developments have been criticized for their inability to contain or reduce costs as the major impediment to universal access to quality care in the long-term perspective (Jay & Priya, 2018; DPE, 2016). Combining relevant empirical and conceptual evidences, the paper discusses the access, cost and quality of health care delivery as well as quality measurement initiatives adopted within the U.S. Health Care system. The overall discussion also reflects on the relationship between quality measures and evaluation and role development of the Advanced Practice Nurse (APN). Nursing Shortage Assignment Paper

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The Access Component

According to Joel (2017), access is described as the capacity to receive care, health care and/or related services and goods. Whilst the rising demand for affordable and quality care has pushed many of health-care reforms and role developments for the APN, access to health care services is also considered to be an important variable in determining health status and outcomes of care in different settings. Sezer and Bauer (2017) argued that access to healthcare and coordinated care remains a major issue affecting millions of vulnerable populations in rural and urban environments. Whilst a series of special payment initiatives (Medicare, Medicaid) have since been adopted to enhance access to healthcare across the continuum of care, millions of Americans could be categorized as vulnerable populations due to persistent lack of access to primary care services; high rates of underinsurance and insurance; high unemployment rates; low health literacy levels; cultural differences (linguistic, cultural and social barriers); socio-economic differences (poverty), socio-demographic differences (age, ethnicity) and environmental challenges (air pollution, unsafe streets, among others) (Maxey et al 2015). Salmond and Echevarria (2017) insisted that, the health insurance in the country is characterized by uneven coverage and rising healthcare premiums, with estimates showing that close to 32 million Americans are currently uninsured, majority of whom are poor and often minorities.  Whilst adoption of the Affordable Care Act (ACA) paved the way for expansion of health insurance to American adults, the absence of comprehensive health insurance is projected to cost the United States a significant amount of financial resources to the tune of $280 billion every year due loss of productivity, reduced human capital and other associated costs (Agency for Healthcare Research and Quality, 2016). International Council of Nurses (2015) added that more than forty million workers (in both full-time and part-time employment) in the United States have no access to health and insurance benefits at their respective workplaces, and this is an issue that has greatly undermined access to quality, safe and affordable care among the vulnerable populations with pre-existing conditions.

The Cost component

The high cost of healthcare is also regarded to be another major issue affecting the performance of the healthcare system in the United States (Joel, 2017; Agency for Healthcare Research and Quality, 2016). Whilst seeking to determine whether the disproportionately higher cost of health care represents a manifestation of corporate greed, Mathur and Srivastava (2016) found out that, the country spend more than $3 trillion annually on health care alone, representing close to 18% of the Gross Domestic Product (GDP), and approximately $9,300 on each individual every year in the form of healthcare costs. The study noted that since 2010, a growing number of U.S.-based pharmaceutical companies have actively increased the prices of life saving drugs including Daraprim for treatment of HIV patients (from $13.50 to $750 per tablet), EpiPen utilised for treatment of anaphylactic shock (from $57 to $415 for a pack of 2 EpiPen), among others (Mathur & Srivastava, 2016). Whilst the U.S. federal government has been in the past engaged in regulation of drug prices (as it is in the case of the state Medicaid programs), the passage of increased prices of drugs and devises to the payer (private insurers or government and/or consumer has mainly favored the creation of massive profits for the manufacturers and health care providers (Agency for Healthcare Research and Quality, 2016). A key conclusion is that the privatization of medicine in the U.S. healthcare through consolidation and mergers opened ways to increased health care costs, decreased competition and enhanced monopoly of a few health systems (Salmond & Echevarria, 2017).

The cost component could also be attributed to the existence of flawed re-imbursement methodology adopted for many of the health care services (Joel, 2017). Jay and Priya (2018) noted that although the fee-for-service reimbursement model is adopted universally to streamline health care delivery through enhanced access and improved quality, concerns over increased billing by physicians for the health care services offered to patients are mounting. Sezer and Bauer (2017) clarified that, the provision of unnecessary care in many of the profit-oriented health care facilities not only contributes to increases in overall healthcare costs but also may prove detrimental to the patient and the roles and responsibilities assumed by the hospital-based APNs. In another study that conducted a comparison of nursing shortages in the United States with other mature economies in the OECD area, the DPE (2016) revealed that, whilst the current U.S. healthcare system has undergone tremendous policy reforms and institutional changes, there exist notable differences in care in terms of total health expenditures, health care costs and outcomes. Vertical integration of health care and consolidation as well as massive administrative costs and cost of billing and insurance are largely responsible for the unfavorable costs in the United States when compared to other OECD countries (DPE, 2016). Ideally, the widespread adoption of modern ICTs will have tremendous impact on the role development of APNs due to the increased need for relevant skills and knowledge for using these new technologies to enhance access, reduce cost and boost quality of care (Joel, 2017). Nursing Shortage Assignment Paper

The Quality component

In an empirical study that focused on examining the influence of key legislative and policies on development of the America’s health care system, Maxey et al (2015) indicated that the system is characterized by a myriad of inefficiencies and complexities that contributes to reduced overall quality of health care. Other key concerns include reduced access to health care services, raised costs (e.g. higher health insurance premiums), diminished consumer choice and decreased competition among health care practitioners due to restricted range of offered services and nursing shortages (Salmond & Echevarria,2017). Joel (2017) claimed that the introduction of competitive market forces and the use of incentive to stir creativity and innovation in the health care markets can contribute to reduced prices and improvements in access and quality of health care services. Alongside stringent legislative and institutional interventions, the reduced competitiveness of health care markets in the United States is also cited to be a major contributing factor to the reduced quality, wanting outcomes and exorbitant prices of health care services and goods (Jay & Priya 2018).

Other empirical studies asserted that the wanting quality of care in the U.S. health care could be attributed to the changing roles of the APNs and of other health care professionals (Joel, 2017; Salmond & Echevarria, 2017). Salmond and Echevarria (2017) pointed out the massive nursing turnovers (between 5% to 37% annual) has had detrimental effects on the annual operating budget, reduced patient safety, and concerns over the existence of unfavorable organizational culture and climate in U.S. hospitals and other health care facilities. Maxey et al (2015) noted that concerns over reduced quality of care may also be deeply examined by looking at the extent and scope of neglected care. Using the systematic review methodology, the study revealed that despite the crucial importance of various forms of care as provided by the APN for improving population health (namely: mental health care, clinical preventive services, oral health care, care of people with chronic conditions, and substance abuse treatment), the prevailing organizational structure and financing of health care and insurance services offer limited coverage, and oftentimes no coverage, for these types of care services (Maxey et al 2015). As a result, some of the major problems in quality of care includes noteworthy disparities in health care due to a number of identifiable characteristics including socio-economic status (income) race or ethnicity, gender, disability, education, place of residence, sexual orientation, among others (Agency for Healthcare Research and Quality, 2016). Secondly, the health care system has witnessed a significant rise in the prevalence of chronic diseases, especially amongst the elderly populations amidst serious concerns over the lack of comprehensive chronic disease management initiatives (Salmond & Echevarria, 2017). Equally, other empirical findings indicated that the overall capacity of the U.S. health care to deliver quality care has also been significantly undermined by the unbalanced resources and strong focus on controlling costs; shortages of APNs; under-representation of ethnic and racial minorities in the health care system; rising hospital nursing shortage; and fundamental systematic inefficiencies in the care delivery and insurance arrangements (Maxey et al 2015).

Recent Quality Initiatives

Numerous quality interventions have so far been designed and adopted to strengthen the quality of the nation’s healthcare system (Joel, 2017). The Agency for Healthcare Research and Quality (AHRQ) mentioned that the critical value of quality measurement is based on the extent to which it can lead to a better understanding of the impact of health care services and goods on quality performance, care outcomes and RNs role development (Agency for Healthcare Research and Quality, 2016). A number of government agencies such as the Centers for Medicare & Medicaid Services (CMC) and AHRQ have been mandated with undertaking comprehensive research programs (internal and external) as well as educational interventions aimed at enhancing the quality and outcomes of health care (Joel, 2017). Besides their renowned regulatory functions, other key goals of these agencies that affect the role development of APNs include enhancing access to effective and proper care services, responding to medical errors and patient safety and diminishing health care costs. Some of the recent initiatives conducted by AHQE included conducting an extensive Q&A project on the types of prescriptive medications capable of leading to improved outcomes and cost-effective care (Joel, 2017). The CMS is the main purchaser (Medicaid and Medicare) in the country and hence tasked with adopting quality initiatives and programs aimed at improving the quality and performance of different facilities including hospitals, long-term care, and home-based health care through strong focus on outcome-based quality improvements.  Equally, other recent initiatives geared at measuring and reporting on care quality are conducted by national organizations (e.g. The American Health Quality Association) private sector entities representing employers, foundations, professional firms and purchasers as well as state governments such New York, Washington and Florida (Joel, 2017; Agency for Healthcare Research and Quality, 2016). Nursing Shortage Assignment Paper

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Conclusion

Advanced Practice Nurses (APN) assume a central role in the development and delivery of accessible, safe, top-quality and patient-centered care in different health care settings. The lack of effective quality measures could heavily exacerbate the current hospital nursing shortage, further undermining the role of the APN as members of inter-professional teams within the hospital work settings amidst significant growth in patient population. These transformative changes requires APNs to acquire and apply relevant skills, competencies, attitudes and knowledge to enhance their contribution in the attainment of highly coordinated, patient-centered care and support through a good deal of inter-professional collaboration.    

References

Agency for Healthcare Research and Quality (2016). 2016 National Healthcare Quality and Disparities Report. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/overview.html

DPE, (2016).The U.S. Health Care System: An International Perspective. https://www.dpeaflcio.org/factsheets/the-us-health-care-system-an-international-perspective

International Council of Nurses, (2015).Nurses: A Force for Change Care Effective, Cost Effective. http://www.denosa.org.za/DAdmin/upload/news/IND_2015-Eng1.pdf

Jay, B. & Priya, B. (2018).Invited Commentaries Ensuring Access to Quality Health Care in Vulnerable Communities. Academic Medicine, 93(9), 1271-1275.doi: 10.1097/ACM.0000000000002254

Joel, L. (2017).Advanced Practice Nursing: Essentials for Role Development. New York: Rutledge.

Mathur, P. & Srivastava, S. (2016).High Cost of Healthcare in the United States-A Manifestation of Corporate Greed. Journal of Forensic Medicine, 1(1),1-4.DOI: 10.4172/2472-1026.1000103

Maxey, H. & Norwood, W.C. & Osbourn, L. (2015).The U.S. Health System. In book: Clinical Informatics Study Guide (pp.23-46). DOI: 10.1007/978-3-319-22753-5_2

Salmond, S.W. & Echevarria, M. (2017).Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12-15. doi:10.1097/NOR.0000000000000308

Sezer, M/ & Bauer, F. (2017).Introduction to the U.S. Health Care System.https://epub.uni-bayreuth.de/3438/1/Kap%201%20Sezer%20Bauer.pdf

Nursing Shortage Assignment Paper