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A healthcare policy is a set of rules and regulations that are put into effect to assist in the operation and the shape of health delivery. A healthcare policy covers a range of issue including public health, chronic illness and disability, long-term care, the financing of health care, preventive health care and mental health. There are two models of a healthcare which consist of the single payer and the social insurance system. In the single payer model, taxes are paid to the government which then pays healthcare providers such as nurses, doctors, and dentists to provide health services to individuals. In a social insurance system, citizens must purchase health insurance from non-profit insurance companies who will then use this health insurance to pay for services provided by healthcare providers. Healthcare is financed through private insurance companies which individuals can access through their employers and for the many Americans that are uninsured, there are three programs in which they can go through called Medicare, Medicaid, and The State Children’s Health Insurance Program. Medicare mainly deals with Americans who are over the age of 65 or disabled. Medicaid deals with people who are of low income or maybe classified as being poor. The State Children’s Health Insurance Program deals with people who are uninsured or low income children. There are so many aspects that can make up healthcare policy and there will be many more that will have an impact on healthcare in the future.
Principles of US Health Policy
There are many principal features of the United States health policy, but to name a few critical ones are: government as subsidiary to the private sector; fragmented, incremental, and piecemeal reform; pluralistic politics; the decentralized role of the states; and the impact of presidential leadership. These key characteristics of health policy work together or separately to pressure the progress and growth of health policy to benefit the country.
The United Sates is one of the few countries in the world that does have a national health care system where their government pays the majority and is the leader in the health care organization. That is not the case in the US. The private sector is the leader and the government takes a back seat in the majority of the development of health policies. It is funny that Americans prefer to have as less involvement from the government as possible in relation to health care financing, delivery, and policy. Being a capital nation we are under the notion that the private sector can best organize and operate the production and consumption of goods and services in our country rather than the government.
The US health care system is fragmented so much that it is almost impossible to track. Employers provide a voluntary insurance program to their employees that are paid for through payments from employees and employers together. Then you have the elderly you are covered through Social Security tax, government subsidized voluntary insurance for physician, supplementary, and prescription drug coverage. The indigent obtain health care through Medicaid which is funded through federal, state, and local revenues. American Indians, Congress, members of the armed forces, Veterans, and the executive branch have health insurance that is financed through the federal government directly. Any type of reform in America is incremental and piecemeal especially health care. For example Medicaid has had many much needed changes since its beginning in 1965. First, Congress changed the policy to have more children become eligible and in 1984 pregnant women and children in two parent families were granted health care if income restrictions were met. Policy changes are met with an array of complex political roadblocks that make much needed reform difficult to accomplish. Often it takes a revolutionary presidential election to overcome such barriers.
As in any other policy debates in the US politics interest groups’ pluralism have an effect on the health policy. Powerful interest groups involved in health care politics adamantly resist any major change (Alford 1975). Each group deeply believes that their interests are the best and will fight very hard to protect their interest. For instance, American Association of Retired Persons (AARP) is a nonprofit, nonpartisan membership organization for American citizens over the age of 50. They are one of the most powerful lobbying groups in the United States with over 40 million members. Because they are such a well organized interest group they are very effective in influencing the decisions on policies that affect the seniors in this country.
A decentralized role of the states has its pros and cons. The states provide financial support for the indigent and disabled through comprehensive health care programs. They also take on the additional responsibility of implementing the governments Medicaid and SCHIP programs for the elderly and children. On the flip side critics have suggested there is too much state control in regards to health policy changes. With each state having control over their own health policy decisions makes it extremely difficult to create a unified national health care policy.
New presidents have always been the stepping stone for policy changes in America. Every president from Johnson to Bush has made an attempt to reform health care in some shape or form. The most recent major historical change has come with the election of President Obama. He has done what no other President has done, Health Care Reform. He is putting the control of peoples’ health care needs in their own hands. President Obama’s presidential leadership impact will reform health care by making it more affordable, making insurance companies accountable for their actions, and provide coverage to all Americans.
Development of legislative health policy
“Health policy is a set course of action undertaken by governments or health care organizations to obtain a desired health outcome” (Cherry & Trotter Betts, 2005). The health care system, including the public and private segment, with the political forces influence how systems are shaped by the health care policy-making processes. Public health policies start from local, state, or federal legislation, regulations which manage the terms of health care services. There are also institutional or business policies related to health care in addition to public policies. In the private sector the policies are developed by hospitals, accrediting organizations, or managed care organizations. Nurses, the largest number of health care providers are the most familiar with institutional policies including those developed and implemented by the Joint Commission on Accreditation of Healthcare Organizations.
“The decision making in the public or the private sector, the scope of the issue, and the nature of the policy all have an impact on the characteristics of a policy” (Thurber,1996). A basic understanding of the policy process is the first step in having a strategy on how to encourage potential power and control important changes in the health care system. It is a process that uses multiple points of access in order to provide a vision that influences the decision makers involved at each stage. There are three stages of policy making: the formulation stage, the implementation and the evaluation stage. In the formulation stage, input of information, ideas, organizations, research from key people and interest groups are put together. The implementation stage involves disseminating the collected information and starting to put the policy into action. During this stage, “the proposed policy is transformed into a plan of action” (International Council of Nurses, 2005). Public policy endorsed by local, state, or federal governmental identities is usually put into practice through the normal process that interprets the policy into a written set of rules issued by the government agency that is responsible for overseeing the policy.
All concerned groups contribute in the development of health care policy by providing necessary information needed to decide on the implementation. Nurses are a very important part in the preparation and implementation of the policy. As the largest one group of health care providers, nurses can successfully sponsor health care policy project; they also have a distinctive point of view on health care policies and expertise to share with the responsible agents. Nurses are a strong voice and active advocated group that leads to positive change and build consensus on important issues.
“The policy process also includes an evaluation and modification phase when existing policies are revisited and may be amended or rewritten to adjust to changing circumstances” (Longest, 2006). Most major public policies are subject to modifications in this process. Smaller changes in already existing policies are usually easier to be implemented than major changes as less clarification and efforts are required to be implemented. A good example would be when the Medicare Program has undergone since its enactment in 1965. Another change is when the U.S. Congress in 1998 added nurse practitioners and clinical nurse specialists as providers that can bill for Part B services they provide to Medicare beneficiaries. Congress has changed Medicare program many times after that and put a number of preventive services to the Medicare program. The most recent change was done to Medicare Part D and added a prescription drug program available for Medicare beneficiaries.
“Health care issue moves through the phases of the policy process, from a proposal to an actual program that can be enacted, implemented, and evaluated, the policy process is impacted by the preferences and influences of elected officials, other individuals, organizations, and special interest groups” (Longest, 2006). “Political interactions take place when people get involved in the process of making decisions, making compromises, and taking actions that determine who gets what in the health care system. Special interest groups and individuals with a stake in the fate of a health care policy use all kinds of influencing, communication, negotiation, conflict management, critical thinking, and problem solving skills in the political arena to obtain their desired outcome” (Cherry & Trotter Betts, 2005; Kalisch & Kalisch, 1982).
Health care system is continuously changing, nurses in many institutions are taking the advocacy role, working together to reflect nursing’s perception in health care policies and to be implemented. However, the legislative process needs to be well understood and policy advocates should be aware that they may run the risk of working with the wrong people or at the wrong time and therefore the policy may not be established. Well prepared professionals can always find ways to promote for a better health care system. For the more experienced professional there are many resources available to nurse policy advocates who want to learn more about how to make a difference in key health care issues using legislative and policy processes and working within the political arena.
The Future of Health Policy
The future of health policy is unknown and difficult to predict. The US has struggled with conquering the health care system as one comprehensive unit. Instead, there have been individual attempts at specific problems, resulting in fragmented solutions. The anti-socialist views of the US citizens have thus far prevented a nationalized health care system, but this has not and will not stop many influential leaders from trying. Regardless of health care being a universal or disjointed system, the future of health policy aims at containing costs, increasing access, and improving quality.
On March 2010, President Obama signed a health care reform bill. A preliminary estimate claims that the bill will reduce the deficit by $130 billion in the first ten years and by $1.2 trillion in the next ten years (Jackson & Nolen, 2010). State-based insurance exchanges will be implemented as a way to purchase insurance for those who do not have access through their employer. The Medicare prescription coverage “donut hole” will be closed by 2020 and seniors will receive a 50% discount on brand name medications. Medicaid will be expanded, will include childless adults, and illegal immigrants will not be eligible. Insurance companies will no longer be able to deny coverage based on preexisting conditions and children will be able to stay on their parents’ insurance plans until age 26. Beginning in 2014, there will be an individual mandate that everyone must have health insurance or have to pay a fine, with exceptions for low-income people. Employers with greater than 50 employees will be required to offer health insurance. There is no telling what the ultimate success will be of this bill, as it is a continued hot debate between political parties, but it puts some definition on the future of health policy.
The role of state governments in health care has become more substantial. They hold the majority of the responsibility for regulating all aspects of the health care system. In addition, states contribute to financing Medicaid services, finance health coverage for state/public employees and retirees, and subsidize the costs of health care services for the uninsured. States also have the role of protecting the public’s health through controlling the spread of communicable diseases, protecting the environment, preventing injuries, promoting healthy behaviors, responding to disasters, providing health services to those without access, monitoring the population’s health status, and developing health care policies to benefit the community. The future of health policy shows that states will continue to perform these roles.
In closing, we feel that an issue such as healthcare must be thought through and have a decision made based on the need of the American peoples as well as the needs of the American economy. By this we mean that a decision should be developed based on a way to keep this great country from going bankrupt or prevent the American people from going broke when a plan goes into effect. In today’s world, the U.S health Care System of today is turning into a disaster because many people are getting to the point to where they are not able to afford healthcare services due to the fact that they are not able to afford it or have lost their jobs are may have partial health care benefits. We feel that all Americans must try to stand up for what they believe and fight for a healthcare policy that will enable everyone to be able to have healthcare coverage so that our government will see that there is a need for a change in the future.
1. Shi, L. & Singh, D.A. (2008.) Delivering Health Care in America: A Systems Approach (4th ed.). Sudbury, MA: Jones and Bartlett Publishers
2. Jackson, J. & Nolen, J. (March 23, 2010). “Health Care Reform Bill Summary: A Look At What’s in the Bill.” cbsnews.com. Retrieved, April 20, 2010, from: http://www.cbsnews.com/8301-503544_162-20000846-503544.html.
3. Alford, R. R. 1975. Health Care Politics: Ideology and interest group barriers to reform. Chicago: University of Chicago Press.
4. S M Williams-Crowe and T V Aultman, State health agencies and the legislative policy process. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403499/?page=1
5. Pamela White, Tobie H. Olsan, Carolanne Bianchi, Theresa Glessner, Pamela Mapstone, Legislative: Searching for Health Policy Information on the Internet: An Essential Advocacy Skill. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN
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