Politics and The Law, the Health Care System,Economics of Health Care,week3
Politics and The Law
The Health Care System
Economics of Health Care
Read chapters 10, 11 & 12 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions;
- Discuss the power of nursing to influence and change health policy.
- Mention and discuss current health policy issues.
- Describe and discuss the organization of the public health care system at the federal, state, and local levels.
- Analyze the influence of socio-cultural, political, economic, ethical, and religious factors that influence the health and culturally diverse individuals, groups, and communities.
As stated in the syllabus, present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 3 discussion questions,” and the SafeAssign exercise in the assignment tab of the blackboard which is a mandatory requirement. A minimum of 2 evidence-based references (besides the class textbook), references can’t be more than five years old. You must post two replies on different dates to any of your peers sustained with the proper references no older than five years as well and make sure the references are quoted properly in your assignment. You can’t post the replies on the same day, and I must see different dates in the replies to verify attendance.
You must quote the references in the assignment; if not, it is considered plagiarism.
A minimum of 800 words is required (excluding the first and reference page). Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.
Please check your assignment after the week is due, or after it, the assignment is grade because I either made comments or ask for clarification in some replies or the assignment that required your response.
Chapter 10
Policy, Politics, Legislation, and Community Health Nursing
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Nurses Who Made a Difference…
Florence Nightingale
Sojourner Truth
Clara Barton
Lavinia Dock
Lillian Wald
Mary Breckenridge
Susie Walking Bear Yellowtail
Florence Wald
Ruth Watson Lubic
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nurses’ Historical and Current Activity in Health Care Policy
Florence Nightingale
First nurse to exert political pressure on a government
Transformed military health
Knew the value of data in influencing policy
Collected and analyzed data about health services and outcomes, which now is a critical element of public health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/Florence_Nightingale
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Sojourner Truth
Advocate for abolishing slavery
Supported women’s rights
Helped transform racist and sexist policies that limited health and well-being of blacks and women
Fought for human rights
Lobbied for funds to educate nurses and physicians
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Carte_de_visite
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Clara Barton
Organized relief efforts during U.S. Civil War
Persuaded Congress to ratify the Treaty of Geneva, which allowed the Red Cross to perform humanitarian efforts in times of peace
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:WcbbustCBarton
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Lavinia Dock
Prolific writer and political activist
Campaigned to allow nurses to control the nursing profession
Advocated for women’s right to vote
Worked closely with Isabel Hampton Robb and Mary Adelaide Nutting to found forerunner to NLN
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Lavinia_Lloyd_Dock
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Lillian Wald
Recognized connection between health and social conditions
Advocate for development of the Children’s Bureau in 1912
Frequently appeared at White House in development of national and international policy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Lillian_Wald_-_William_Valentine_Schevill
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Mary Breckenridge
Developed nursing in rural Kentucky
Established Frontier Nursing Service
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:WENDOVER
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Florence Wald
Nursing leader in establishing hospice care in the United States
Modeled hospice after similar services offered in United Kingdom
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Hospice_Media_Logo
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Susie Walking Bear Yellowtail
Walked from reservation to reservation to improve health services for Native Americans
Established Native American
Nurses Association
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Ketchican_totem_pole_2
Nurses’ Historical and Current Activity in Health Care Policy (Cont.)
Ruth Watson Lubic
Nurse-midwife who crusaded for freestanding birth centers in the United States
Leader in community-based birth center movement
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Photo credit:
http://commons.wikimedia.org/wiki/File:Silverton_Hospital_birth_center_-_Silverton,_Oregon.JPG
Definitions to Know
Social justice
Laws
Public health law
Statutes
Organizations
Professional associations
Policy
Public policy
Health policy
Nursing policy
Institutional policies
Organizational policies
Social policy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions
Policy denotes a course of action to be followed by a government, business, or institution to obtain a desired effect.
Public policy denotes precepts and standards formed by governmental bodies (legislative, executive, or judicial) that are of fundamental concern to the state and the whole of the general public.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions (Cont.)
Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal.
Nursing policy specifies nursing leadership that influences and shapes health policy and nursing practice.
Institutional policies are rules that govern worksites and identify the institution’s goals, operation, and treatment of employees.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions (Cont.)
Organizational policies are rules that govern organizations and their positions on issues with which the organization is concerned (Mason et al., 2007).
Social policy is policy associated with individuals and communities. In very general terms, social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions (Cont.)
Laws are rules of conduct or procedure; they result from a combination of legislation, judicial decisions, constitutional decisions, and administrative actions.
Public health law focuses on legal issues in public health practice and on the public health effects of legal practice. Public health law typically has three major areas of practice: police power, disease and injury prevention, and the law of populations.
Statutes are any laws passed by a legislative body at the federal, state, or local level.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Definitions (Cont.)
Organizations are associations that set and enforce standards in a particular area; a group of individuals who voluntarily enter into an agreement to accomplish a purpose.
A professional association is a nonprofit organization seeking to further a particular profession, the interests of individuals engaged in that profession, and the public interest.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Policy is based on values, and the first step in forming policy is identification of the issue. Therefore, it would seem rational to define “health” as the starting point for any policy annexed to health care issues.
Many Healthy People 2020 objectives directly or indirectly involve health policy.
– Nies and McEwen, 2015
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Shifts in Philosophy at the CDC
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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From Centers for Disease Control and Prevention: State of the CDC: fiscal year 2008, The Author.
From… To…
Disease orientation Health protection focus
Designing and implementing sponsored programs Informing and guiding health system actors
Allocating agency resources Leveraging resources to steer larger health system
Emphasis on clinical prevention Focus on prevention and health protection
Transaction-based relationships Partnerships and strategic alliances
Program requirements Incentives for participation/cooperation
Collecting and analyzing health data Creating integrated health information systems
Issuing advisories and guidelines Building decision-support system
Healthy People 2020
Vision
A society in which all people live long, healthy lives.
Overarching Goals
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nies: Power Points, Evolve Resources for Nies/McEwen: Community Health Nursing, 4th ed.
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Overview of Health Policy
Public Health Policies
Decisions made at all levels of government (local, state, or federal)
Influence health care through monitoring, production, provision, and financing of health care services
Everyone is affected, from providers to consumers
Influence all health care organizations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Overview of Health Policy (Cont.)
Public Health System
Authority for public health vested with states
Responsibility delineated by constitution
Compliance with federal program standards is voluntary but impacted by revenue
Policies influenced by social and political theories
Economics is one factor in decision making
Decisions are slow and deliberate and more reactive
Needs determined by voting shifts, electoral realignment, and term limits
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Overview of Health Policy (Cont.)
Private Health Sector
Includes employers, professional organizations, nonprofit health care organizations, and for-profit corporations that deliver, insure, or fund health care services outside of government control
Policies evolve differently—influenced by economics and business management
Economics is central factor in decision making
Decisions are swift and proactive
Needs determined by consumerism, market trends, and economics
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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How a Bill Becomes a Law
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Figure 10-1. From publicdomainclip-art.blogspot.com/2007_09_01_archive.html. Retrieved October 19, 2009.
Impact of Federal Legislation on Health Care
Prevention of illness by influencing the environment
Provision of funding to support programs that influence health care
Increased the involvement of state and local governments in health care
Promoted similarities of services in all states
Funding resulted in increased regulations
Standardized U.S. public health policy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation Related to Health Care
Pure Food and Drug Act of 1906
Manufacturing, labeling, and sale of food
Children’s Bureau Act of 1912
Regulated unhealthy child labor practices
Shepherd-Towner Act in 1921 extended to infants
Social Security Act of 1935; 1965; 1972
Benefits for mothers, children, elderly, disabled
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Medicare (Title XVIII) in 1965
Health care services for people over 65, with permanent disabilities, and those with end-stage renal disease
Medicaid (Title XIX) in 1965
Combined federal and state program
Access to care for poor and medically needy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Public Health Act of 1944
Consolidated all existing public health legislation into one law
Health services for migratory workers
Family planning services
Health research facilities
National Institute of Health (NIH)
Nurse training acts
Traineeships for graduate students in public health
Home health services for Alzheimer’s disease patients
Prevention and primary care services
Rural health clinics
Communicable disease control
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
McCarren-Ferguson Act of 1945
Gave states right to regulate insurance plans
Hill-Burton Act of 1946
Federal assistance in construction of hospitals with stipulations about service for the uninsured
Health Amendments Act of 1956; Title II
Funds for RN education in administration, supervision, and teaching
1964 Nurses Training Act: funds for loans and scholarships and to develop more nursing schools
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Occupational Safety and Health Act of 1970
Focused on health needs and risks in workplace and environment
Health Maintenance Organization Act of 1973
Employers must offer federally qualified HMOs as health care option to employees
States had oversight on HMOs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
National Health Planning and Resources Act of 1974
Assigned responsibility for health planning to states and local health system agencies
Required health care facilities to obtain prior approval for expansion in form of Certificate of Need (CON)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Omnibus Budget and Reconciliation Acts
1981, 1987, 1989, and 1990
Enacted to reduce huge federal deficit
Impacted funding for nursing homes, home health agencies, and hospitals
Established new guidelines and regulations including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
Amendment to SSA of 1935
Established PPS for Medicare, the DRG system
COBRA of 1985
Requires all EDs that participate in Medicare to provide care for all, regardless of ability to pay
Ensures continuation of insurance after loss of job
Example of how federal government can affect state health care practices
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Family Support Act of 1988
Expanded coverage for poor women and children
Expanded Aid to Families with Dependent Children (AFDC)
Health Objectives Planning Act of 1990
Response to the first Healthy People report (1979)
United States began to identify and monitor national health goals; Healthy People 2000, 2010, and 2020
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Ensured portability of insurance coverage
Offered protection for patient privacy and confidentiality
Welfare Reform Act of 1996
Restricted eligibility for AFDC, Medicaid, etc.
TANF helped move recipients into work; welfare offered temporary assistance
Many underserved lost Medicaid coverage
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
The State Child Health Improvement Act (SCHIP) of 1997; 2009
Provides insurance for children and families who cannot afford health insurance
Medicare Modernization Act of 2003
Most significant law in 40 years for senior health care
Provides seniors and disabled with some Rx drug benefit coverage, more choice, and better benefits
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Nurse Reinvestment Act of 2003
Funding provided to increase enrollments and number of practicing nurses
Mental Health Parity and Addictions Equity Act of 2008
Financial requirements (deductibles, co-payments) and treatment limitations (number of visits; days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Patient Protection and Affordable Care Act of 2010
All U.S. citizens and legal residents to have qualifying health coverage
Changes eligibility requirements for Medicaid and expands CHIPS
Subsidizes premiums for lower and middle income families
Requires coverage of dependent adult children up to age 26
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Patient Protection and Affordable Care Act of 2010 (Cont.)
Significant insurance reforms
Established high-risk pools
Covers preexisting conditions
No lifetime limits on coverage
Cannot drop policyholders when they get sick
Must provide preventive care and screenings without customer cost-sharing
Fosters nonprofit, member-run exchanges
Implemented over several years
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Critical Federal Legislation
Related to Health Care (Cont.)
Patient Protection and Affordable Care Act of 2010 (Cont.)
Funded through new fees and taxes.
Taxes on indoor tanning
Medicare taxes for higher income brackets
Fees for pharmaceutical companies and medical devices
Penalties for those who do not obtain health insurance
Cost-cutting measures
Cuts to Medicare Advantage programs
Reductions in Medicare spending
Reduce administrative costs, streamline care, reduce fraud and abuse
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The health reform legislation in 2010 was strongly influenced by the rising number of uninsured and underinsured.
The United States is only major developed country to not have universal health coverage.
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State Legislative Role
Focus on financing and delivery of services and oversight of insurance to address the mission of public health throughout the state
Assess health needs
Ensure adequate statutory base for health activities
Establish statewide health objectives
Ensure appropriate organized statewide effort to develop and maintain essential services
Guarantee minimum set of essential health services
Support local service capacity
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Effective Use of Nurses: A Policy Issue
Title VII funding (HRSA) provides the largest source of federal funding for nursing education
Favors education for practice in rural and medically underserved communities
Nursing shortage is a crisis
Economic impact on positions
Focus on hiring BSN graduates (not ADN)
Shortage of nursing faculty
Nurse Education, Expansion, and Development Act of 2009 amended above to increase funds for nursing schools
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Nurses’ Roles in Political Activities
The Power of One and Many
…as Change Agents
…with Coalitions
…as Lobbyists
…on Political Action Committees (PACs)
…in Campaigning
…in Voting Strength
…in Public Office
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