Thank you for your post. I agree that the rapidly rising cost of healthcare is a serious issue in our country. I too see the impact on the patients seen in the emergency department. Uninsured patients will come in for toothaches or sore throats because they cannot be turned away for inability to pay and no payment is required at the time of service. They have no primary doctor willing to see them. In researching this issue I found information on the proposal of universal healthcare. Though controversial, it has been introduced as one solution to this problem.
According to Galvani et. al. (2020), the provision of universal healthcare would entail expanded utilization of health services by those who are currently uninsured and those who are insured but for whom cost still imposes a barrier to health care. As you mentioned, the uninsured and underinsured tend to forgo necessary treatments and preventative measures. According to Galvani et. al. (2020), individuals without any insurance utilize healthcare at 50.1% of the rate of adequately insured individuals. There are also 41 million underinsured Americans who have insurance plans with prohibitively high deductibles and/or copays. Underinsured individuals utilize healthcare 86% less than adequately insured individuals. With universal healthcare coverage, it is presumed that healthcare utilization by both uninsured and underinsured individuals would rise to the level of adequately insured individuals for whom cost does not discourage healthcare utilization (Galvani et. al., 2020). As you pointed out, healthcare access and affordability are not the same. Having health insurance does not automatically grant patients financial access to needed care. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care (Manchikanti et. al., 2017). The gap between providing patients the mechanism of paying for healthcare and actually receiving it needs to be addressed.
References
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet (London, England), 395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3
Manchikanti, L., Helm Ii, S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?. Pain physician, 20(3), 111–138.
Sample Answer 3 for NURS 6053 Discussion: Review of Current Healthcare Issues
Global healthcare systems are facing unprecedented times and uncertain future based on the current situation of Covid-19 pandemic. This has prompted quick adoption of technology in healthcare systems from booking of appointments to billing. Therefore, I believe one of the major current healthcare issues is on technology disruption. Much questions have been raised on the big data usage, incorporation of telehealth, synchronization of the national health data systems and on the confidentiality and security of the patient’s health records as cases of cybersecurity have soared with increased adoption of information technology in healthcare (Sittig et al., 2018).
Big data in healthcare systems refers to the accumulation of large sets of digital information about the patients’ biodata, medical history, clinical interventions, current and past medical concerns of the patients. This data is accumulated overtime rather than that which is received in small amounts and not stored for future references (Thew, 2016). This prompts the healthcare nurse informatics to employ the use of data analytics and data mining tools so that they can extract meaningful patterns, study the correlation and develop predictions (McGonigle & Mastrian, 2018). Use big data has proved to be essential in healthcare management especially when analyzed and used to inform critical decision-making points and even guide future evidence-based change projects (Byrd et al, 2018). This information is used by managers and administrators to identify patterns and areas of strength and weakness within the system and help plan in resource allocation.
However, big data faces one of the greatest security challenges especially on the confidentiality of the patient’s information. Cases of cyber insecurity have been rising since most healthcare facilities and organizations adopted use of technology to manage the spread of Covid-19 pandemic. The patient’s confidential data may be easily accessed if the systems security checks are not well enforced. In some of the online platforms like Amazon, for online shopping, the systems put in adequate security checks and user authentication and verification steps. The breech of patient’s confidential medical information could have adverse effects on the healthcare facility or organization hence incur a lot of expenses in terms of compensation and in the end the reputation of the organization will also be severely damaged.
Therefore, it is imperative for healthcare organizations and systems that procure any digital platform for managing healthcare records to invest heavily on ensuring the system is safe and secure from cyber security threats and phishing on patient’s data (Bibhuranjan, 2019). Moreover, there is need to improve the software technology to develop systems that are less susceptible to hacking. It is also essential to ensure that patients are well educated on ways of safely using the digital platforms and there should be readily accessible customer care agent to help patient’s carry out proper verification and maintain safety of their data.
Increased usage of digital platforms and information technology poses another safety threat to the patients as they are likely to seek for medical advice from online blogs and unverified media sources that could be misleading to the patients. This information collected on such blogs has no scientifically proven or evidence-based data to support the claims or the medical advice offered. Moreover, the information could be provided by individuals who have no professional training in the areas that they are providing the medical information. There has been rapid increase in blogs from unregistered dietician and fitness coaches whose methods are not scientifically viable to rely on as professional medical procedures. Many patients have fallen prey to such misleading information that even sometimes discourages the use of conventional medication and clinical intervention measures (Young, 2016).
In conclusion, it is imperative for the federal and state government to come up with strict measures, laws and policies that govern the use of information technology in healthcare. The guidelines should be clear and the regulations must be standardized to enhance security of the patients’ data and also safeguard them from unverified and unethical practices and information availed to them on social media platforms. Any digital platforms or media engaging in medical or clinical information must have passed the licensure criteria that would be guided by strict conformity to the ethical issues in healthcare and meets the set standards.
References
Bibhuranjan. (2019). Big data analytics – How beneficial is it for healthcare? Technofaq. https://technofaq.org/posts/2019/05/big-data-analytics-how-beneficial-is-it-for-healthcare/#:~:text=%20Big%20Data%20Analytics-%20Benefits%20in%20the%20Healthcare,is%20very%20important%20for%20any%20organization…%20More
Byrd, T.A., Kung, L., & Wang, Y. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3-13. doi:10. 1016/j.techfore.2015.12.019
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2018). Current challenges in health information technology–related patient safety. Health Informatics Journal, 26(1), 146045821881489. https://doi.org/10.1177/1460458218814893
Thew, J. (2016). Big data means big potential, changes for nurse execs. HealthLeaders. https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs
Young, A. (2016). The pros and cons of big data in the healthcare industry. HealthCareZone. https://www.healthtechzone.com/topics/healthcare/articles/2016/11/18/427248-pros-cons-big-data-the-healthcare-industry.htm
Sample Answer 4 for NURS 6053 Discussion: Review of Current Healthcare Issues
Thank you for the informative discussion post on health equity and affordability in healthcare. As you pointed out, reaching out to the uninsured is one avenue to attaining a healthy populace. Affordable care act legislation was geared to address the inequalities of insured persons and their access to health care. It also encompassed the quadruple aim to assure quality, satisfaction, individualized care and cost containment on service delivery.
A value based reimbursement by CMS was adopted as an oversight to quality against the traditional service for fee system that neglected optimal care to maximize profits. As observed by Goldman & Sommers, “Medicaid enrollees and are associated with delayed health care access and reduced medication adherence. Little is known about the effect on churning of the expansion of eligibility for Medicaid under the Affordable Care Act (ACA), which had the potential to reduce coverage disruptions”, (Goldman, A. L., & Sommers, B. D., 2020). Addresses and attempts to bridge the gap and disruption of coverage in the continuum of care.
Equity in healthcare has been elusive in considerations to the many dynamics that play into it. With ACA legislation, Lipton, Decker & Sommers found out, “that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites”, (Lipton, B. J., Decker, S. L., & Sommers, B. D., 2019).
Affordability enhances access to care and improves larger population health and eases continuum of care.
Zao et al., in their article summarizes that, “The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage”, (Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X., 2020). Affirming contribution to the discussion of needed policy implementation to ensure successful and optimal care delivery.
References
Goldman, A. L., & Sommers, B. D. (2020). Among Low-Income Adults Enrolled In Medicaid, Churning Decreased After The Affordable Care Act: This study examines whether the Affordable Care Act’s expansion of Medicaid eligibility had an impact on coverage disruptions–known as “churning”–among Medicaid enrollees. Health affairs, 39(1), 85-93.
Lipton, B. J., Decker, S. L., & Sommers, B. D. (2019). The Affordable Care Act appears to have narrowed racial and ethnic disparities in insurance coverage and access to care among young adults. Medical Care Research and Review, 76(1), 32-55.
Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: a review at 10 years. CA: a cancer journal for clinicians, 70(3), 165-181.
Sample Answer 5 for NURS 6053 Discussion: Review of Current Healthcare Issues
Patients should receive high-quality care in safe environments. However, multiple healthcare issues impede healthcare organizations’ ability to achieve this goal while increasing management costs, among other adverse outcomes. A national healthcare issue significantly affecting the work setting is a nursing shortage. In the United States, the nursing shortage is a multifaceted problem caused by the influx of patients in healthcare facilities, high nurse turnover, an aging population, and poor working conditions (Hamlin, 2023; Tamata et al., 2023). Potential impacts of the nursing shortage on the work setting include increased nurse burnout, patient dissatisfaction with care, overcrowding, and extended hospital stays. Understanding the complexity and multidimensional nature of the issue can help healthcare leaders implement sustainable solutions to mitigate its effects on patients, the nursing workforce, and healthcare organizations.
Social determinants of health (SDOH) affect the nursing shortage in various dimensions. For instance, problems increasing vulnerability to chronic diseases lead to a proportional increase in the number of patients seeking care in healthcare settings (Barrio-Cortes et al., 2021). Environments characterized by poor access to healthy foods and facilities that promote physical activities increase the risk of lifestyle diseases. Inadequate access to care increases the risk of hospitalization for preventable diseases. Education also influences health choices, including practices, behaviors, and decisions regarding when and where to seek healthcare support.
Healthcare settings respond differently to the nursing shortage. Broome and Marshall (2021) mentioned the practicality of telemedicine, collaborative care, and new models in response to the shortage of primary care providers. In the current workplace, nurse empowerment programs to prevent nurse turnover play a significant role in addressing the nursing shortage problem. Besides, there is an intensified effort to provide tech-based care to improve access to care and reduce physical patient visits in the facility. Supportive leadership also helps healthcare workers to understand and respond to work-related stress (Greco et al., 2022). More leadership support is among the changes needed to enable the current workforce to respond to stressors related to the nursing shortage and work optimally.
References
Barrio-Cortes, J., Soria-Ruiz-Ogarrio, M., Martínez-Cuevas, M., Castaño-Reguillo, A., Bandeira-de Oliveira, M., Beca-Martínez, M. T., … & Jaime-Sisó, M. Á. (2021). Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups. BMC health services research, 21, 1-13. https://doi.org/10.1186/s12913-021-07020-z
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Greco, E., Graziano, E. A., Stella, G. P., Mastrodascio, M., & Cedrone, F. (2022). The impact of leadership on perceived work-related stress in healthcare facilities organizations. Journal of organizational change management, 35(4/5), 734-748. https://doi.org/10.1108/JOCM-07-2021-0201
Hamlin, K. (2023). Why is there a nursing shortage? Nurse Journal. https://nursejournal.org/articles/why-is-there-a-nursing-shortage/
Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing open, 10(3), 1247-1257. https://doi.org/10.1002/nop2.1434
Sample Answer 6 for NURS 6053 Discussion: Review of Current Healthcare Issues
High Cost of Care
The National Healthcare Issue I will be discussing is High Cost of Care
Description of National Health Issue (High Cost of Care)
U.S healthcare cost is the highest globally, although the U.S is rated high regarding patient-centered care. The continuous upward cost of U.S healthcare costs has created economic hardship for some families in America (Lyford & Lash, 2019). Many quality issues are noted within the healthcare system. For example, medical errors have been attributed to several thousands of leaks per year in America, lack of transparency leading to fraud is noticeable in the U.S healthcare system, coding system has caused clashes between healthcare providers and insurance companies, and the policyholders have become the bargaining chips.
Up code is a way providers extort money from insurance companies, and insurance companies, on the other hand, may introduce higher premiums to the employers. There are also challenges in getting competent Doctors; health consumers need access to information about doctors’ credentials and accomplishments, making it difficult to make an informed decision. In America, the high cost of healthcare is linked to new technology, and money is pumped into training and managing new Electronic Health Records and Electronic Medical records. Most of these expenses come from the operational and staff cost required to be in charge of these new systems. In America, prescription drugs and diagnostic tests are so exorbitant. Increasing transparency is synonymous with reducing costs. For example, Drug companies never affix any price to their product when advertising it on TV. A significant way to facilitate transparency is by asking drug makers to disclose the cost of their products in media advertisements (Garness, 2019).
Various steps the government has taken to reduce the cost of healthcare have proven futile. Providing healthcare consumers with necessary and adequate information to better their health and teaching consumers about preventive screenings will reduce the risk of preventable conditions and save the cost of healthcare services.
When consumers are well educated about their health, it brings down demands for health services, potentially lowering healthcare service prices. Healthcare professionals are restructuring care to facilitate positive patient outcomes in combating the high cost of healthcare services. Healthcare professionals face the problem of creating new ways to restructure care and create systems that make providers liable for standard, cost, and patient care outcomes (Ricketts & Fraher, 2013).
How High Costs of Care May Impact My Work Settings
I work in a hospital. Many people in America either delayed or did not get healthcare services for cost reasons. Costs of healthcare services are the most debilitating factor to healthcare access. People with lower income and uninsured have difficulties affording healthcare costs. The rich and those with healthcare insurance also pay a very high price for healthcare services. The high price of healthcare can either make the patient skip or delay pursuing healthcare services.
The increase in the cost of healthcare services is linked to the quantity, not quality, of services. The advent of new technologies is driving the cost upward. There needs to be more information regarding medical services, and cost implication is also responsible for high costs. Doctors are scared of malpractice lawsuits and engage in defensive medicine; this leads to the prescription of irrelevant tests, and this practice drives up the cost. Some studies have shown that some patients spent more on healthcare services than their income could support.
In my hospital, patients are suspending care services because of healthcare costs. Most canceled healthcare appointments or procedures are traceable to the high cost, and appointments get canceled when patients receive high estimates. Even though patients know that untreated medical condition can aggravate, resulting in worsening symptoms, when a patient postpones care, cancel, or delay, it causes workflow disruptions. Revenue is lost, necessary clinician time is wasted, and it leads to a lack of inefficient care delivery.
The patient is shopping for providers that guarantee a positive patient payment experience. Without any doubt, when patients receive surprise bills, they will be tempted to search for different providers. This is a nightmare for healthcare providers. When patients switch providers, such providers will lose revenue and may be unable to meet their financial obligations. For a healthcare provider to maintain a competitive edge, such must offer a better payment experience. The increase in healthcare services costs is affecting healthcare organizations’ revenue generation. For providers to stay afloat, they must provide the best financial experience.
My hospital cuts jobs and reduces services in my workplace due to increasing costs and strain budgets. As the execution of the U.S Affordable Care Act moves, several healthcare systems seek considerable changes in how the healthcare workforce is sorted out (Pittman & Scilly-Russ, 2016). Also, the COVID-19 pandemic has put a strain on the hospital budget. Our hospital is paying high wages to healthcare workers due to shortages, and this is driving the cost of healthcare upward.
As a result of this shortage, my organization scaled back services. In the hospital I worked, we have been experiencing low procedure volumes and supply chain issues post-pandemic. Hospital payroll has gone above the ceiling. The cost of healthcare delivery had made my healthcare organization cut executive compensation and readjusted workloads. Contract workers were switched to full-time employees, and existing staff were retained at a minimum wage increase. Some patient do not mind travelling for healthcare services to reduce the cost. As a way of increasing profitability, my workplace has resulted in reducing nurse staffing. The nursing staffing ratio directly relates to the quality of patient care outcomes. Reducing staffing has contributed to nurse burnout as nurses ended up working long, and nurse’s burnout has been the cause of high nurse turnover. Increased nursing turnover has been the source of an increase in overtime pay. Nurse burnout affects staff morale and productivity, as nurse turnover affects the nurse-patient ratio.
Social Determinant that Most Affect High Cost of Care
Social determinant of health includes stigma, disparity, poverty, racism, and lack of education. Social determinant of health are the situations in the surrounding where people work or live, and social determinant plays a vital role in quality-of-life outcomes. Health disparities, education discrimination, literacy, etc., contribute to arrays of health disparities and inequities. Socioeconomic factors encircle many several social determinants of health. Poverty can inhibit access to quality healthcare. Social determinant of health is not a medical factor, but they impact health outcomes. In this case, poverty and lack of education are social determinants that most affect the high cost of care.
How My Health System Work Setting Has Responded to the High Cost of Health Services
Because there are intermediaries between healthcare providers and patients, many sick patients are paying a high price to get treated. My health system implemented cost containment, and this facility designs effective cost-containment strategies to alleviate the cost of care without compromising high-quality care. Cost containment has led to the creation of new payment models and revamped care delivery (Palumbo et al., 2017).
My health system work setting responded to the high cost of healthcare through cost containment. Promoting comprehension of organizational costs, encouraging engagement throughout the hospital, having frequent meetings with the stakeholders, stressing the correlation between labor costs and productivity, and making available powerful tools for data-directed decision-making.
Using generic medicines, and asking the patient to do a routine health screening, enables the detection of health problems early, and if diseases are treated early, it saves cost. To alleviate the cost on the side of the patient, patients are advised to use in-Network Health care providers to save money. The management first communicates the plan to implement cost containment around all hospital departments. Essential expenditure and revenue data are passed to all stakeholders, so they must learn the rationale behind cost containment.
The appropriate authority can translate data and expose clinicians to insights into the system’s financial operations. Stakeholders such as doctors and nurse practitioners were provided with adequate financial data to enable them to make appropriate adjustments as they could potentially drive-up costs. Exposing cost data to frontline decision-makers in the healthcare system is a difficult decision. The reason for high healthcare costs can be linked to advancements in medical technology, the aging population, and the cost of labor.
To lower the cost of healthcare services, our hospital utilizes Telehealth, which has brought meaningful saving substantial financial savings to the hospital. The patient is seen virtually by doctors. These strategies were initiated at the inception of the COVID-19 pandemic. These strategies help the hospital to save money, and the patient does not have to make unnecessary trips to the emergency department which can make the patient cough out thousands of dollars per visit. Hospitals throughout the nations are adapting to these changes using the theory of complex adaptive systems. Complex Adaptive Systems theory is considered one feature of complexity science that describes how an organization adapts to an ever-evolving environment (Marshall & Broome, 2021).
References
Garness, K. (2019). The Challenge of High Drug Prices in America: Cost Disclosure in Direct-to-Consumer Advertising May Offer a Solution. American Health & Drug Benefits, 12(5), 254–255.
Lyford, S., & Lash, T. A. (2019). America’s Healthcare Cost Crisis: As the costs of U.S. healthcare continue to escalate, three commonsense reforms could reverse this unsustainable trend. Generations, 7–12.
Marshall, E. S., & Broome, M. (2021). Transformational leadership in nursing (3rd ed.). Springer Publishing Company.
Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation? Journal of Professional Nursing, 33(6), 400–404. https://doi.org/10.1016/j.profnurs.2016.11.005Links to an external site.
Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(1). https://doi.org/10.1186/s12960-016-0154-3Links to an external site.
Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11). https://www.proquest.com/docview/1458313016?accountid=14872%26forcedol=trueLinks to an external site.
