Please reply to the following students.
Student 1
The way that physicians and other personnel get paid is by the number of procedures, consultations, and patient visits that each patient pays for. However, that does not take into account patient outcomes. Whether the patient outcome is good or bad, the physicians and hospitals get paid for the more work they do. Something that the ACA has tried to push for is for physicians to build a quality service protocol that includes providing quality-care, with positive outcomes, and Medicaid beneficiaries (Short, 2022). Therefore, the provider gets paid more if they have good patient outcome. The problem with that theory is that the better patient outcomes are, the less hospital stays, procedures, and consultations an individual should have. Therefore, less procedures are done, so less pay. This creates an incentive problem for provides and hospitals (Short, 2022). A problem that I have witnessed while practicing as a nurse is that patients’ hospital bills vary depending on the type of health care he or she has. When procedures, medications, or any hospital interventions are done, patients are unaware the cost. They receive a bill at the end of the month stating how much they owe. I have seen patients become frustrated because they want to feel better and listen to medical professionals, but they are also in a hard financial spot of their life. Some patients sign out against medical advice because of the lack of financial transparency. As a nurse, something that I could do to try to solve this problem is to push for hospital finance transparency. The Healthcare Blue Book was established to give more price clarity. It shows the fairest price of a certain procedure or clinic visit based on their healthcare coverage. It is similar to the Kelley Blue Book for used cars (Beck, 2014). I believe allowing a bit of price transparency can allow patients to feel like they have some advocacy for their own care. That also may prevent them from being blind-sided about what prices they are paying for.
Nicole Hassoun argues that every individual should require easy access to healthcare because it it their human right and each should at least have minimal access, regardless of financial status, religion, ethnicity, etc (Hausman, 2024). Daniel Hausman states that although her argument is correct and logical, it is difficult to specify “minimal”. He uses the example of homeless individuals seen begging the streets for money for food and shelter (Hausman, 2024). It is unknown each of their stories as they vary. Some homeless individuals made poor choices, some have cognitive disorders, and some have simply run out of money to provide sufficient care for their family. However, Americans do not have a mandatory duty to provide money for these beggars on the street. Hausman believes that is a state’s duty. Our taxes cover that expense. He believes that the money that each state has collected to support those in most financial need, such as the homeless population, should be 100% accounted for (Hausman, 2024). If the money is not properly given to individuals in the correct way or there is some unclarity where taxpayer money is going, the state has failed not only the taxpayers, but the homeless who definitely need the financial assistance (Hausman, 2024). The cycle is a frustrating circle that seems to be never-ending and needing the perfect balance of ethical and political correctness.
References
Beck, Melinda (2014, February 23). How to bring the price of health care into the open. Wall Street Journal. Retrieved from http://online.wsj.com/news/articles/SB10001424052702303650204579375242842086688Links to an external site.
Hausman, D. M. (2024). Is there a human right to essential health care? Developing World Bioethics, 24(1), 6–9. https://doi- org.ezproxy.memphis.edu/10.1111/dewb.12362
Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.
Student 2
Describe a situation from your practice when you have seen the effects of how health care is financed influence outcomes for a patient or patients. What could you as a nurse or nursing do to influence a change in health policy that would change this in the future?
From my eight years of experience as a registered nurse, I have witnessed the effects of healthcare financing on patient outcomes. In my current practice at MGA Homecare as the Clinical Director, most patients receive funding for their private-duty nursing through Medicaid programs. Unfortunately, Medicaid can reduce nursing hours or decide the patient is not qualified to receive home nursing services. When this happens, pediatric patients suffer and often frequent hospitalizations and a decreased quality of life (Heller et al., 2023).
As a nurse, there are several actions I can take to positively influence a change in health policy to address issues in the future. One action that I frequently utilize is educating families on their right to appeal Medicaid decisions, as most parents are not aware that they can appeal or know the process necessary to receive an override of the current decision (Hajizadeh et al., 2021). Another action that I can take is to raise awareness and advocate for policy changes in the current private-duty nursing standards through Medicaid (Wakefield et al., 2021). By actively engaging in policy discussions, nurses can raise awareness of healthcare financing and push for reforms to improve private-duty nursing coverage for patients. A nurse who is proactive in addressing how patient outcomes are influenced by healthcare financing promotes health equity and quality care for all individuals (Morris, 2024).
What is the reasoned, logical response to concerns that health care is not a right. Tax dollars should not be directed toward health care because it costs too much and provides too little.
Healthcare funded by tax dollars is a broad topic of discussion with varying perspectives. A logical response to the agreement is that, as a society, it is morally and ethically imperative to ensure all individuals have access to medical care regardless of their financial status (Binkley, 2020). While healthcare is expensive, investing in primary care and preventative care services can be more cost-effective than the alternative of emergency interventions. Preventative measures and promoting a healthy lifestyle can reduce treatments for advanced diseases. Also, many countries have universal healthcare systems that provide coverage for all citizens, typically funded by taxation. Promoting a universal healthcare system provides comprehensive care and controls costs while ensuring all individuals can achieve better health outcomes (Berwick, 2020). While concerns are valid about the cost and efficiency of healthcare funded by tax dollars, it is often justified that quality healthcare should be available to all individuals regardless of their ability to pay for the services (Crowley et al., 2020).
References
Berwick, D. (2020). The moral determinants of health. JAMA 324(3), 225-226. https://doi.org/10.1001/jama.2020.11129
Binkley, C. (2020, December 6). A right or a privilege? How to practically and ethically
reconcile two opposing views of health care. Makula Center for Applied Ethics. https://www.scu.edu/ethics-spotlight/post-election-reconciliation/a-right-or-a-privilege- how-to-practically-and-ethically-reconcile-two-opposing-views-of-health-care/
Crowley, R., Daniel, H., Conney, T, Engel, L. (2020). Envisioning a better U.S. health care system for all: Coverage and cost of care. Annals of Internal Medicine 172(2), 7-32. https://doi.org/10.7326/M19-2415
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021).
Factors influencing nurses participation in the health policy-making process: A systematic review. BMC Nursing 20(128), 1-9. https://doi.org/ 10.1186/s12912-021- 00648-6
Heller, R., Joshi, A., Sircar, R., & Hayatghaibi, S. (2023). Medicaid and the children’s health I insurance program: An overview for the pediatric radiologist. Pediatr Radiol 53(6), 1179- 1187. https://doi.org/10.1007/s00247-023-05640-7Links to an external site.
Morris, G. (2024). Why policy engagement is the next big nursing trend. Nurse Journal. https://nursejournal.org/articles/the-role-of-nurses-in-policy-engagement/
Wakefield, M., Williams, D., Le Menestrel, S., & Flaubert, J. (2021). The role of nurses in improving health equity. National Academies Press.
