Increasing Consumer participation in the Policy Process…

Over the past fourteen weeks this blog has discussed in considerable detail the policy making process and the different factors involved. One of the biggest factors that can affect the policy process is the involvement from the consumers. At first glance, policy-making can appear to be a complex and at times tedious task for lawmakers and lobbyists; albeit true at times, policy-making in this current day and age has also been simplified in many ways. To affect changes in policy, it does not take a law degree or a position as a legislator, but it does take knowledge and the willingness to act. Decisions that effect day-to-day operations in one’s community happen at the local level by local officials and the efforts of one or several people coming together can positively impact those policies (Institute for Local Government, 2014).
Consumers armed with the knowledge of an issue and with the will to act can effectively champion for policy through a number of strategies. Perhaps the most helpful strategies that consumers can depend on is to “communicate effectively and stay engaged” (ILG, 2014). Communicating effectively includes being clear and direct in your position and stance with officials; highlight the issue from a local and personal perspective and make sure to allow and address any resistance (ILG, 2014). Staying engaged in the policy issue is also imperative in the process and includes keeping communication open between local officials, community partners, and other individuals united for the cause while monitoring results and looking out for implementation (ILG, 2014).
From a personal perspective, the policy process has been illuminated and simplified over the past few months during my policy course. While participating in lobby days and trips to the Capitol can be an effective way to see policy change, it can also involve the simplest acts such as writing e-mails, making phone calls, signing petitions, or sending a letter to your local legislator. Every avenue to reach out is an opportunity to have your voice heard no matter your race, creed, or educational background.
As the efforts to champion for independent nurse practitioner practice in California continues, it is important to remember that while change does not happen overnight, it does happen. It is a culmination of voices, of efforts, of progress and ultimately of action that leads to success. Membership in professional organizations such as the American Association of Nurse Practitioners (AANP) or local policy groups can help individuals stay connected and knowledgeable on relevant issues and also act as another vehicle to drive the desired change.
References
Institute for Local Government (2014). Working Effectively with Local Officials. Retrieved from http://www.ca-ilg.org/post/working-effectively-local-officials-tip-sheet-members-public-and-local-decision-makers

Sustaining Innovation…

“As technology improves…until it is good enough to compete…it starts to displace…more traditional technology…it wasn’t because digital was better than film…when you see a new technology evolving don’t treat it like a toy because once it settles down and starts to mature it will be very competitive with you…so don’t dismiss new technologies that come up in parallel spaces and parallel markets…take them very seriously because overtime they could disrupt your market.” Travis White on disruptive vs. sustaining innovation.

Innovative environments will only thrive where there is a genuine spirit of innovation, which does not come from the actual organization, but rather the individual people in that system or leaders who encourage and reward innovative thinking and behavior.
According to Howell (2005), presenting any kind of innovation as an opportunity rather than a threat is the biggest difference between “effective and less effective champions” of innovation (p. 112). When it comes to nurse practitioners gaining independence in practice, this concept is more applicable now than ever before, given that some physicians share the personal opinion that nurse practitioners want to rule their turf. In a survey highlighted by U.S News and World Report (2013), originally reported in an issue from the New England Journal of Medicine, approximately 1,000 physicians and nurse practitioners had considerable disagreement on which type of provider gave better care; 66% of the physicians surveyed agreed that given a task to do the same service, the physician would do it better. While it is in the best interest of nurse practitioners, who seem to have aptly demonstrated their position to enhance healthcare delivery by providing quality care, it is just as important for medical organizations and physicians to see that nurse practitioners are not specifically competing with them, they are in a league of their own. Not to say that physicians do not add something to the healthcare field but only to say that it does not need to be a turf war seen as physican vs. nurse practitioner but instead a united front with a collective and shared vision of increasing healthcare to those who need it whether it comes from a nurse practitioner or a physician.

The excerpt above is from the brief but informative and very engaging video clip on disruptive vs. sustaining innovation. While the speaker is speaking about technology and in particular digital vs. film, I thought it was an interesting parallel to physicians vs. nurse practitioners and the continued efforts on behalf of the nurse practitioner community to gain parity as autonomous healthcare providers.

References

Howell, J.M. (2005). The right stuff: Identifying and developing effective champions of innovation. Academy of Management Executive, 19(2), 108-119.

U.S News & World Report (2013). Doctors reluctant to expand nurse practitioners’ role: survey. Retrieved from http://health.usnews.com/health- news/news/articles/2013/05/15/doctors-reluctant-to-expand-nurse-practitioners- role-survey

Health Care Financing: Interview

In the United States, healthcare is financed through a few different avenues which can largely depend on a number of different factors including but not limited to age, employment, military status, and economic status to name a few. For example, individuals involved with the military as well as their families who qualify as dependents may receive their coverage from the federal government (National Institutes of Health, 2013). Medicare, generally designated for adults over the age of 65 or those under 65 who have a physical disability and/or end stage renal disease receive their health care coverage from the federal government as well (United Healthcare, 2014), which approximately 13% of the US population receives according to the National Institute of Health (2013). On the other hand, Medicaid, developed to assist low-income individuals and their families is funded not only by the federal government but also at the state level (United Healthcare, 2014), about which approximately 10% of the US population receives (National Institute of Health, 2013). Often those who are employed receive health care coverage through their employer which could include “traditional indemnity insurance or a managed care plan” which include Preferred Provider Organization (PPO), Point of Service Plans (POS), and Health Maintenance Organization (HMO), approximately 64% of the United States is covered through some form of an employer insurance plan (National Institutes of Health, 2013, par 2).
In the year 2000 alone, health care spending was well estimated to be over a trillion dollars, an increase thought to be attributed to a number of factors including prescription drug spending, aging population, and the high demand for complex and progressive technology (National Institutes of Health, 2013).

The following is an interview with Ms. Natalie Wilson whose professional background includes a degree in actuarial science from the Wharton School from the University of Pennsylvania. She currently works for United Health Group in their finance department for federal government health plans.

As a professional with a background in actuarial science, how would you describe current healthcare spending in the Unites States and do you think that the amount spent on healthcare is appropriate?

No, healthcare spending in the US is inappropriately high due to several contributing factors including rising healthcare costs, steadily increasing hospital and provider prices, wasteful spending and unhealthy lifestyles. Preventable trips to the emergency room and unnecessary procedures are a few examples of wasteful spending at the consumer and provider level. Also, the growing burden of chronic diseases adds significantly to escalating health care costs. Much of this cost is preventable, since many chronic conditions are linked to unhealthy lifestyles. Additionally, advances in medical technology, while expanding the range of treatment options available to patients, have replaced lower-cost options with higher-cost services and contributed significantly to increased health care spending. Another driver is an aging population with an increased life expectancy, which leads to additional healthcare expenditures.

Do you think that with the health care reform initiatives such as the Affordable Care Act, health expenditures will stay the same, increase, or decrease and why?

I expect that health care expenditures will decrease with healthcare reform initiatives. The Affordable Care Act’s provision that insurance policies cover preventative care may also reduce overall long-term health costs based on the premise that if people receive preventative care, they will be less likely to suffer from chronic health conditions that drive increased healthcare spending. An additional cost-cutting tool of the ACA is the penalization of hospitals with reduced government Medicare reimbursements for an excess number of readmits who were released from the hospital and return within a month with specific preventable conditions. Additionally, accountable care organizations will encourage coordinated healthcare for patients amongst hospitals, primary care physicians and other providers to decrease wasteful spending and determine appropriate levels of care.

In your opinion, are there specific areas within the federal healthcare budget that need to be adjusted?

In its current state, Medicare and Medicaid, the federal government’s major healthcare programs, are not sustainable. An aging and longer living population with chronic diseases equates to an increase in unfunded obligations far beyond the scope of current contributions. A stronger push needs to be made to reduce rapidly rising health care costs through healthcare reform in order to ensure that these programs remain funded for future generations.

What recommendations do you have for the federal government in regards to healthcare financing?

I am a firm supporter of the Affordable Care Act and feel that reducing the uninsured population will have a positive long-term impact on healthcare spending in the US. Encouraging preventative care and rewarding providers for coordinating collaborative healthcare plans for members will significantly reduce healthcare spending. I would also encourage increased spending on healthy lifestyle initiatives, as preventable chronic diseases, largely linked to obesity, are causing increased healthcare costs. In addition, modifying doctor incentives to focus on better care rather than fee for service, as addressed in the ACA’s penalization for readmits, will help reduce spending.

References

National Institutes of Health (2013). Health Economics Information Resources: Module 2- Sources and Characteristics of Information Relating to Health Care Financing in the US. Retrieved from http://www.nlm.nih.gov/nichsr/edu/healthecon/02_he_01.html

United Health Care (2014). Medicare vs. Medicaid. Retrieved from http://www.medicaremadeclear.com/about/medicare-vs-medicaid/

Innovation in HealthCare…

According to Herzlinger (2006), there are three valuable kinds of innovation in the healthcare sector which can facilitate the improvement of healthcare and the cost of it, which include innovation that focuses on consumers, technology and business models. There are, in addition, different forces at play which can positively or negatively affect healthcare innovation including public policy, funding, customers, industry players, technology, and accountability (Herzlinger, 2006) all of which alone or collectively can influence the direction of the innovation in the healthcare sector. Innovators in the heathcare sector must be willing to respond to a multitude of challenges, including adapting to change, new technology, and the ability to interact with collaborators across disciplines.
Building upon the discussion last week and change theory, innovation and change are interrelated and require both emotional and situational components (Campbell, 2008). A major characteristic of an innovator in healthcare is communicating a vision amongst other counterparts. According to Campbell (2008), change can be hampered within a system by individuals who adopt the belief that specific changes are unable to be implemented or are not feasible within an organization (p. 31). On the other hand, the innovation cannot be “perceived as too complex or adoption will fail” (Weberg, 2009). Innovation in healthcare is a continual process which is based on a number of factors including history, marketing, context, and time (Weberg, 2009). The promotion of ideas is a key characteristic of the innovator and the one whom is able to get other leaders and stakeholders to notice and appreciate the innovation often prove effective (Howell, 2005) which also aligns with Kotter’s change management vision of communicating for “buy-in” (Campbell, 2008).
The innovator is able to champion for their idea with persistence, conviction, energy and also the willingness to put their reputation and position on the line if it means that the innovation will succeed (Howell, 2005). The innovator is also enthusiastic and while sharing their vision is simultaneously protective of it by avoiding “premature evaluation” of an idea while also being cognizant of new ideas and opportunities (Howell, 2005). In addition the innovator is able to be flexible in their role and also have a broad vision of what their role in the organization which allows for them to often go beyond their call of duty and responsibility which fosters creativity; the innovator also has a broad knowledge base of multiple subjects which allows for them to look for information from different sources (Howell, 2005).

In the journey for nurse practitioner expanded scope of practice in the state of California, the same leaders and organizations persistent in the cause of nurse practitioner autonomy must remain active and persistent in their voice, employing the strength and collaboration of other organizations that “buy-in” to the vision of a healthcare system within California that welcomes competent providers to practice to the full extent of their education.

 

References

Campbell, R. (2008). Change Management in Health Care. The Health Care Manager, 27 (1), pp. 23-39.

Herzlinger, R. (2006). Why Innovation in HealthCare is So Hard. Harvard Business Review, Retrieved from http://www.hbr.org

Howell, J.M. (2005). The right stuff: Identifying and developing effective champions of innovation. Academy of Management Executive, 19(2), 108-119.

Weberg, D. (2009). Innovation in Healthcare: A Concept analysis. Nurs Admin Q, 33(3), 227-237.

Change Theory…

Change almost never happens automatically; nevertheless, it usually always inevitably happens. In the case of organizational change, given the multiple players and stakeholders involved, the road to change can be a lengthy and at times grueling process, especially when there is continued opposition from one or more parties. According to Campbell (2008), there is a common perception that culture change must come before behavioral change, no matter the environment whether it be in sports or business, but he counteracts that belief with John Kotter’s view that a culture will change when “a new way of operating has been shown to succeed over some minimum period of time” (p. 33). John Kotter’s change management model includes 8 nonlinear steps which organizations can use to induce and implement change (Campbell 2008). Each step falls into one of 3 phases which include 1) creating the right climate 2) “engaging and enabling the whole organization” and 3)”implementing and sustaining the change” (Campbell 2008, p. 23). The first phase of “creating a climate for change” includes the steps of increasing the need for urgency, the development of guiding teams, and a right vision (Campbell 2008). The second phase includes the steps to communicate for buy-in, facilitate action and develop “short-term wins”, while the 3^rd phase includes the last of the 8 steps which are “don’t let up” and make it stick” (Campbell 2008, p. 23).

In the case of California and restrictive scope of practice for nurse practitioners, it appears that utilizing steps from the first phase of Kotter’s change model is an appropriate place to start as the laws are not in favor of nurse practitioner autonomy at this current time. As discussed earlier in this blog, California legislature recently refused to pass a bill concerning nurse practitioners (California Healthline, 2014). SB 491 was a bill that proposed revisions by asking that the requirement for nurse practitioners to practice, including being able to diagnosis and prescribe certain drugs and devices, in consultation with a physician and/or surgeon be amended to allow them to perform on their own (SB 491, 2013). There is no denying that the need for urgency has already begun given that California has a shortage of physicians and that only 16 of 58 counties have the “federally recommended ratio of physicians to residents”(Section 1a,SB 491). In addition, with the implementation of the Affordable Care Act, which will help expand coverage for those who are uninsured, specifically 5 million more Californians (Section 1b, SB 491) there will be a need for even more providers that are going to be able to meet primary care needs especially in underserved communities including urban and rural areas (Section 1b, SB 491). Guiding teams in this particular scenario could be neighboring states who have laws which allow for nurse practitioners to practice autonomously, such as a state like Arizona which could serve as one of the many model states which do not restrict practice, a recommendation which even the Institute of Medicine of the Natural Academy of Sciences has recommended (Section 1c, SB 491). It also appears that the vision is there in California but is not a shared vision as many medical communities oppose independent nurse practitioner practice. In an effort to promote the vision, it would be beneficial for policy makers in favor of SB491 to gain support from communities outside of nursing in order to further strengthen their cause and continue to educate on how valuable the nurse practitioner role has been and can continue to be.

“ ‘If your time to you

Is worth savin’

Then you better start swimmin’

Or you’ll sink like a stone

For the times they are a-changin’ ”

(Bob Dylan), taken from Campbell (2008).

 References

California Healthline (2014). Legislature fails to advance nurse practitioner scope-of-practice bill. Retrieved from http://www.californiahealthline.org/articles/2013/9/3/legislature-fails-to-advance-nurse-practitioner-scope-of-practice-bill

Campbell, R. (2008). Change Management in Health Care. The Health Care Manager, 27 (1), pp. 23-39.

 SB491 (2013). Retrieved from http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_491_bill_20130521_amended_sen_v95.html

 

Policy governing access to data and privacy protection…

Over the past century, changes and policies have been adapted and readapted in efforts to protect patient health information. With the new advancements in technology, particularly within the healthcare realm, there has also been simultaneous advancements in policy with regards to protected health data and stricter definitions and guidelines with what information can be accessed including specifying under what conditions it needs to be accessed, and by whom needs to access it, and when. In earlier years, namely towards the end of the twentieth century, medical records were largely regulated by individual states which implemented statutes governing how health information was used (Pritts, 2007). Many of these health privacy laws at the state level were enacted in an effort to push for a patients’ participation in their healthcare by creating an environment to develop trust between provider and patient (Pritts, 2007). Even with these statutes in place, there were varied levels of protection among states whereas some had more detailed privacy protections and others few protections (Pritts, 2007).
The Health Insurance Portability and Accountability Act (HIPAA) developed in 1996 by the Department of Health and Human Services, was comprised of a section that called for a federal legislation safeguarding “privacy and security of protected health information (ePHI)” (Schweitzer 2011). In addition, the development of certain aspects of HIPAA, particularly the administrative simplification provisions, was created to foster an electronic based health information system (Pritts, 2007). While the reasons behind the need for this kind of legislation (HIPAA) were numerous, it was imperative in improving how efficient and effective healthcare was delivered as well as how protected information was exchanged (Schweizer 2011). According to Pritts (2007), HIPAA currently allows for health information to be disclosed for treatment, payment, and healthcare operation services, with the exception of notes taken during psychotherapy, without first getting a patients permission. Nevertheless, HIPAA also allows for individuals to obtain their own medical records, including requesting changes to their records as well as knowing where there records have been disclosed (Flores & Dodier, 2005). Another measure that was created to safeguard protected health information includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was created as a sect of the 2009 American Recovery and Reinvestment Act, that further enforces HIPAA legislation by strongly reinforcing civil and criminal penalities of violating HIPAA by “defining levels of culpability and corresponding penalties.” (Schweitzer 2011). Violation of HIPAA carries some penalties of serious consequence including but not limited to fines up to 1.5 million dollars and serving up to ten years in prison (Schweitzer 2011), both of which are likely meant to serve as deterrents of misusing or abusing protected health information.
Nurse practitioners, several of whom likely practiced as a nurse for some period of time before becoming advanced practice nurses, are well adapted and familiar with HIPAA and the use of electronic medical records. With the continued push for the use of EMR in efforts to protect and identify how health information is being used and for what purposes, there also needs to be recognition that practitioners as autonomous providers can also help continue to promote and protect this valuable agenda which not only aims to protect patients but also maintain relationships centered around a mutual trust and respect that information will not be misused.

With newest technologies in social media like twitter and facebook, the short video included gives some basics about being socially compliant with HIPAA!

References
Flores, J., Dodier, A. (May 31, 2005). “HIPAA: Past, Present and Future Implications for Nurses”. OJIN: The Online Journal of Issues in Nursing.10(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No2May05/tpc27_416020.html

Pritts, J.(2007). Federal Efforts To Impose Uniformity on State Health Information Privacy Laws. Health L. & Policy, 20, Retrieved from https://myasucourses.asu.edu/bbcswebdav/pid-8843735-dt-content-rid-33354263_1/courses/2014Spring-D-DNP711-15383-20787-20788-29255/Pritts2007-FedEffortstoImposeUniformityonStateHealthInfoPrivacyLaws.pdf

Schweitzer, E. (2011). Reconciliation of the Cloud Computing Model with US Federal Electronic Health Record Regulations. Journal of the American Medical Informatics Association, 19, pp. 161-165. Retrieved from https://myasucourses.asu.edu/bbcswebdav/pid-8843728-dt-content-rid-33354260_1/courses/2014Spring-D-DNP711-15383-20787-20788-29255/J%20Am%20Med%20Inform%20Assoc-2012-Schweitzer-161-5.pdf

Private sector innovation and policy advancement….

According to Kraft & Furlong (2012), despite the challenges that several public problems may present, they are an opportunity for both the public and private sectors to positively affect unsatisfactory conditions in an innovative way along with imagining possibilities to a shared solution. Private sectors are described as organizations that are separate from government control, often private companies both large and small that are often for-profit organizations. Nonetheless, it is not out of the ordinary in this day and age for the government, a public sector, most commonly at the local level to employ the use of private sector companies to contract out a wide array of services for them to provide and pay them for doing so even though this constitutes a continued debate as to whether this is a good idea or not among public policy debate (Kraft & Furlong 2012).
The private sector is in a unique position to influence policy both directly and indirectly in addition to both positively and negatively. In a previous post I mentioned the Disney Channel airing a cartoon negatively portraying nurse practitioners as “med school drop-outs” and while this 5 second clip did not have any foreseeable consequences on already restrictive policies keeping nurse practitioners from practicing to their full potential, it was an innovative and negative portrayal simultaneously. But for as negative as certain private sectors can be while being innovative in their approach, there are private sectors which can be innovative and positive in advancing certain healthcare policies.
Johnson & Johnson, a well known pharmaceutical and consumer goods company, has a whole campaign called “Discover Nursing” which was created in 2002 to help address the nursing shortage that the country was facing by aiming to bring more people into the career in order to “preserve the quality and availability of healthcare in the future.” (Johnson & Johnson 2014). This took on the form of commercials portraying and honoring the history and nursing profession and an extension of the campaign in the form of a website where aspiring nurses or nurses looking to advance could get resources for finding schools offering advanced degrees and places that offered continuing education courses. In 2010, AARP, the AARP foundation, and the Robert Wood Johnson Foundation created a similar nursing campaign called Future of Nursing: Campaign for Action which “is grounded in an evidence-based report by the Institute of Medicine that states that transforming nursing education, practice and leadership will help expand access to care, improve quality and reduce costs.” (Robert Wood Johnson Foundation 2014). Private sectors have long recognized that they have the ability to advance whichever agenda they choose to support and in this case, these are example of large private sectors that are working to change healthcare policy and access to care by targeting the nursing profession particularly the education of nurses in hopes of “creating a healthier population” (Robert Wood Johnson Foundation 2014). According to the Robert Wood Johnson Foundation (2014) action coalition leaders are breating partnerships with like minds from other sectors in addition to raising funds and awareness about the IOM call to transform nursing across all 50 states pushing efforts at the state level.

The video attached is an interesting clip on the innovations that different private sectors have utilized!

References

Johnson & Johnson (2014). Discover Nursing. Retrieved from http://www.discovernursing.com/about-us#.Ux0JIl6uJtQ

Kraft, M. E., & Furlong, S. R. (2012). Public Policy: Politics, Analysis, and Alternatives (4th ed.). Thousand Oaks, CA: CQ Press.

Robert Wood Johnson Foundation (2014). Future of Nursing: Campaign for Action. Retrieved from http://www.rwjf.org/Nursing_CampaignforAction

Medicare, Medicaid, and the Affordable Care Act…

       

For the longest time I had a difficult time distinguishing between the differences in Medicare and Medicaid and it was helpful knowing the differentiations between the two types of coverage and how it affects the care people can receive or have access to. Both Medicare and Medicaid are governmental programs who assist people in paying for healthcare but aside from that they are two very different entities and are meant for two different groups of people.

 

            Medicare in general is for adults who are over the age of 65 years old but is also structured to assist those under the age of 65 who may have a physical disability or who are of any age and have end stage renal disease and is funded by the federal government. Medicare can be categorized into parts A, B, C, and D.  Typically part A Medicare covers inpatient stays while part B covers outpatient visits including doctor office visits and part C is a combination of parts A and B usually automatically setup when an individual reaches the age eligibility of 65 years old. Part D is usually reserved for covering prescription drugs. Depending on the type of coverage, costs may vary and can include copays just like other insturance plans (United Healthcare 2014).

 

            Medicare on the other hand is funded at both the state and federal level and was created to assist families with low-income and limited financial resources, and eligibility will vary from state to state. Medicaid coverage typically covers inpatient hospital care including skilled nursing facilities, care received from a facility that has been designated as a federally-qualified health center, and rural health clinics. In addition, Medicaid coverage also includes services provided by a doctor, pediatric and family nurse practitioner. Like Medicare, copays and co-insurance may be required (United Healthcare 2014).

 

            The Affordable care act is an umbrella term that encompasses two different acts which include the Patient Protection and Affordable Care Act and secondly the HealthCare and Education Reconciliation Act. The Affordable Care Act helps expand coverage in that that it helps fill a divide for very poor individuals by developing a “minimum Medicaid income eligibility level” for people in the United States. The Affordable Healthcare Act also allows an entire family who is eligible to apply using one application making it simple and fast to do. The provisions which appear to be quite extensive cover benefits, quality of care and delivery systems, prevention, childrens health insurance programs, and community based long term services just to name a few (Medicaid.gov 2014).  So ultimately, it helps expand coverage, lower health care costs, and expand the choices individuals have when seeking healthcare thereby enhancing quality of care (Medicaid.gov 2014).  For nurse practitioners this expansion of coverage could mean a boost and is a hopeful plug for a push for more autonomy in states in which practice is more restricted such as California.

 

References

 

United Health Care (2014). Medicare vs. Medicaid. Retrieved from http://www.medicaremadeclear.com/about/medicare-vs-medicaid/

 

Medicaid.gov (2014). Affordable Care Act. Retrieved from http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html

 

Public sector influence on healthcare policy: Efforts to aid the uninsured, underinsured, disabled, and decrease health disparities.

California has enacted a program known as the California Health Benefit Exchange for individuals living in California without insurance looking for low-cost or no-cost health coverage. There are many resources already in place for those without insurance including the AIM program (Access for Infants and Mothers ) which is a state program that provides pregnant females and their newborn low-cost health insurance if they fall into low and middle income brackets. California Kids is another resource that offers subsidized healthcare services to children through the age of 18 years old.  The County Medical Services program is a county-based program with people for low incomes who must qualify to participate and also the Family pact program provides family planning services to those seeking such resources (California Department of Managed Health Care 2014).  With resources such as these in place, the system is not completely full proof as there are still several uninsured individuals and the process is not as easy or rapid as it may appear at first glance. Anywhere from the low-income to new graduates to people in between jobs, not having health coverage can not only be a frustrating and discouraging experience but also a fearful situation. Basic medical checkups, labs, and prescriptions that should be easy to access are far from that for those who are uninsured in California.

 

            With California continuing to have restrictive laws against nurse practitioners the disparities and access issues that already exist for those with lack of resources will only continue to grow.  With the overall age of the US population continuing to rise and the introduction of the Affordable Care Act, the need for NP autonomy and independence apart from a physician are more urgent now than ever (California Health Report 2013). Between the uninsured who are most often without insurance due to lack of financial resources and elderly adults who have problems finding a provider who takes Medicare and Medicaid particularly in rural areas which California has many of taking care of simple or chronic health issues becomes a daunting task (California Health Report 2013).  According to the American Academy of Nurse Practitioners the report that that 87% of nurse practitioners take Medicare while 84% accept Medicaid and also that 88% of nurse practitioners are trained in primary care and furthermore between the years of 1998 and 2010, the amount of patients on medicare who received care from nurse practitioners increased fifteen fold (California Health Report 2013).  By continuing to limit the scope of practice for nurse practitoners who are limited by the need for a physician presence in order to function as a provider, access to care will continue to be an issue not only for those in rural areas but for the low-income, uninsured and underinsured who are already limited in their choices and places to seek quality care.

 

 

 

References

 

 

 

Graebner, L. (2013).  Nurse practitioners seek independence amid growing need for primary care. Retrieved from http://www.healthycal.org/archives/13604

 

 

 

California Department of Managed Health Care (2014).  Retrieved from http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_uninsured.aspx

 

 

 

 

 

 

 

The process of healthcare policy-making…

Th                  The process of healthcare policy-making as discussed previously in this blog is a complex one often complicated by the different players and the different levels of influence as this process often involves more institutions than just the government, private institutions such as Joint Commission on Accreditation of Healthcare Orgnizations (JCAHO) as one example are also involved in this process whether directly or indirectly (Field 2007). In addition, the Department of Health and Human Services, which is the umbrella organization for several agencies that play a role in regulating health care in the United States is an important structure to be familiar with when it comes to understanding the process of healthcare policy-making (Field 2007).

 

                        There are two forms of state law, statutes and regulations, legislature is responsible for forming statutes and state agencies which fall under government executive branches are responsible for regulations (Buppert 2012). According to Field (2007) a regulatory action “may not be arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.”  In addition, regulations should not contradict statutes and are often an expansion of statutes with more details of government administration (Buppert 2012). Also for further clarification, regulation can be seen as rules that preside over a programs operations and also specify in which way an agency makes its decisions in order to remain consistent with the law [Coursen PPT Contextual and Philosophical dimensions of public policy]. In the case of nurse practitioners, most of the laws at the state level concerning practice can be seen in regulations while some is statutory; for example, under state regulation for a nurse practitioner falls categories such as prescriptive authority, basis for license suspension, revocation, or nonrenewal, scope of practice, requirements for licensure, requirement of collaboration or supervision, reimbursement under Medicaid, requirements of educational programs, and standards of practice to name a few (Buppert 2012). In California, the Board of Nursing mandates regulatory law concerning nurse practitioners as opposed to Alabama for example which is regulated by the Joint Committee of Board of Medical Examiners and the Board of Nursing.  As previously mentioned, some states determine scope of practice in statute which is enforced by state legislature and in others, legislature gives boards of nursing influence over defining what a nurse practitioner can and cannot do (Buppert 2012) In California, Nurse practitioner qualifications include holding a registered nurse license, “certification by a national or state organization or documentation of remediation of areas of deficiency in course content and/or clinical experience and verification by a nurse practitioner and by a physician who meet the requirements for faculty members specified in Section 1484c of clinical competence in the delivery of primary health care.”(Buppert 2012).

References

 

Buppert, C. (2012). Nurse Practitioner’s Business Practice and Legal guide. Massachusetts: Jones and Bartlett.

Coursen, C. The Contextual and Philosophical Dimensions of Public Policy [PPT]. Retrieved from https://myasucourses.asu.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_277887_1

 

Field, R. (2007). Health Care Regulation in America: Complexity, Confrontation and Compromise. Retrieved from http://www.healthcareregulation.net/Health%20Care%20Regulation%20Teacher%27s%20Guide.pdf

 

 

 

 

 

Th