Advocate for Health Care Policy Assignment Paper

First Steps on Becoming a Grassroots Lobbyist/Advocate for Health Care Policy

This assignment has two parts, numbered below. Write each question as a new topic area, then follow with a paragraph or two to answer the question. You may find it necessary to search for answers to the questions outside of the assigned reading. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.Advocate for Health Care Policy Assignment Paper

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Tasks:

1.Imagine that you are going to make a visit to your representative in Congress. Develop a one-page document that supports your position on the AHCA that you would leave with your representative or his or her aide when you make your visit. This one-pager, also called a “leave behind,” should state your position clearly in bullet points and give your reasons why your position is preferred. This “leave behind” should have 1 inch margins and utilize 14-point font throughout. If you were making this visit in person, you would present your “leave behind” to the person with whom you speak during your visit. Include a second page that describes your rationale for the position in your “leave behind” page supported by at least two journal articles.

2.Write a two-page brief to describe the scenario surrounding your legislative visit. Understanding the political affiliation of your representative, include answers to the following:

•Was your member in support or in opposition to the AHCA?

•State three points that you would cover in support or opposition to your representative’s position.Advocate for Health Care Policy Assignment Paper

•How does your nursing experience influence the advocacy position that you take on the AHCA?

Nursing is the largest medical profession in the world with nearly 4 million nurses in the United States alone. As such, nurses have the potential to profoundly influence policy and politics on a global scale. In fact, it is the moral and professional obligation of nurses to be engaged in legislation that impacts their patients. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Unfortunately, nurses have historically had little involvement in policy that affects healthcare delivery.

There are several reasons for the limited nursing participation in policy and politics. Lack of awareness, inadequate skills, and little opportunity for involvement are just a few factors. Another barrier is the limited formal health care policy education in nursing. Time and resources are further obstacles to the nursing profession’s participation in politics. Additionally, studies show that nurses are not given sufficient support to generate the evidence needed to influence healthcare policy.Advocate for Health Care Policy Assignment Paper

Regardless of the multiple factors limiting the nursing profession’s potential impact on politics, the fact remains that nurses are vital to the development and implementation of healthcare policy. As the largest medical profession in the world, nurses should be leading the way in redesigning the healthcare system. But in order to do so, they will need to partner with members of other medical professions such as physicians. For this to happen, nurses must be skilled in patient care as well as in interdisciplinary teamwork, informatics and technology, implementing evidence-based practice, and quality improvement.

All too often, nurses become frustrated by policies affecting nursing practice, particularly when those policies are written by individuals with limited healthcare knowledge and experience. This frustration often leads to negativity, disillusionment, bitterness, and burn-out. Instead, nurses should channel their frustrations into making a positive difference in their profession. As Oestberg states, “As nurses, we need to think of policy as something we can influence, not just something that happens to us.”

The truth is, any nurse can influence policy and politics at the local, state, and federal levels. Locally, nurses can become politically active by assuming leadership positions in the healthcare system or contacting elected officials about legislation affecting the industry. Nurses can obtain formal training in politics, become involved in city councils and committees, or even run for local office. And something as simple as exercising the right to vote can impact healthcare policy.

At the state and federal level, nurses can get involved in policy and politics by joining a professional nursing organization. These organizations often have lobbyists that bring nursing issues to Capitol Hill. Nurses can also write their state representatives regarding healthcare policy. Nurses can undertake internships with elected officials to personally work on matters affecting healthcare. And nurses can even run for state office — there are two nurses currently serving in the Florida State Legislature.Advocate for Health Care Policy Assignment Paper

As Oestberg so succinctly points out, “If nurses don’t stand up for issues that are important to us, those with competing interests in healthcare may be the only ones whose voices are heard.” By joining their voices together, American nurses can influence the policy and politics that affect healthcare. Marquis and Huston define politics as “the art of using legitimate power wisely.” The nursing profession has significant power to profoundly impact healthcare policy on a global scale. Additionally, the nurses of today are younger, more educated, and more diverse. They bring more energy, more ideas, and more ingenuity to the nursing profession. Perhaps they will even bring more political activism.

However, nurses need support in order to effect change. And that support starts at home. Families and friends of nurses need to encourage political activism. Nursing schools need to include healthcare policy education as part of the curriculum, as well as encourage some level of political involvement from nursing students. Furthermore, the faculty of nursing schools should also participate in policy changes, thereby acting as role models for their students. Finally, employers need to provide staff nurses with the time, resources, and opportunities to influence local, state and federal policy. After all, healthcare legislation ultimately affects us all.Advocate for Health Care Policy Assignment Paper

My patients invited me into their homes, where I observed the forces that shaped their lives and health — things like stress, neighborhood safety, access to food, social support, education level and whether they had health insurance. I witnessed, as nurses do every day, how people’s environment tremendously affected their health, and how the kind of insurance my patients had, or lacked, played a significant role in the care that I could — or couldn’t — provide.

Nursing is a challenging profession, yet even as I got caught up in the details of the many things nurses do, I wondered about the powerful social and environmental factors that contributed to the health of the people I saw. I realized that as a nurse if I could influence those factors through policy — the regulations created as solutions to problems — I could affect thousands of people or more.

My career since then as a nurse involved in public policy has been rich and varied. I’ve held leadership positions in state government and co-lead a center for state health policy. I’ve taught, and conducted research. I lead AARP’s Public Policy Institute and serve as the chief strategist at its Center to Champion Nursing in America, where I help lead the Future of Nursing: Campaign for Action, a national initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation that is working to build healthier communities through nursing. CCNA is an initiative of those same three organizations.

While my curiosity drove me to shift direction in my nursing career, such a change isn’t for everyone. Nurses are needed in direct care and in communities more than ever. But I believe this: What makes for more powerful nursing is at least being aware of how policy rulings can affect you and the people you care for.

Public policy’s impact

Public policy can mean the difference between someone having health insurance or not. It affects the type of care that a person can get and whether or not the care they receive is covered by their insurance. It affects the cost of prescription drugs, copay’s, deductibles and covered services. And as nurses, it has a tremendous influence on our working environment.

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Public policy affects how and where nurses can practice and what we can do. In 29 states, nurse practitioners cannot practice to the full extent of their education and training because of outdated legal hurdles. Nurse practitioners in these states face barriers such as being required to find a physician to supervise them (often at great cost) in order to diagnose, treat and prescribe medications to their patients, even though nurses in other states can practice without these restrictions. At CCNA, we are working to remove these barriers. Since 2010, we’ve helped to change laws in nine states so that these advanced practice nurses can provide full care.Advocate for Health Care Policy Assignment Paper

All of us were drawn to nursing because we want to help people. And because policy affects us all, knowing what’s happening in the world around you is one way to get involved. Being an informed nurse and citizen gives you insight and understanding of the world, and how and why decisions are made. It allows you to make connections and have conversations you might not ordinarily have. It also makes you knowledgeable in work and life.

So how do you get there? Pay attention to current events — especially the politics of healthcare, vote attend professional conferences, join a state or national nursing organization, and consider joining your state’s Campaign for Action state affiliate. These experiences might even lead you to a leadership position.

As nurses, we understand the healthcare needs of individuals, families and communities. But when nurses take a broad view and understand the greater influences at work, it helps us as a profession be a more effective force in improving the health of our nation.

As direct caregivers, nurses spend more time with patients than healthcare providers in most other disciplines. So decision makers need to hear from nurses. If we don’t stand up for the issues that are important to us, those with competing interests in healthcare may be the only ones whose voices are heard.

By knowing how the system works and which strategies can effectively influence policy, any nurse can become an advocate at the local, state, or federal level. You can make phone calls to elected representatives about bills under consideration, testify before committees, become involved in practice councils or boards at the workplace, and even run for elected office.Advocate for Health Care Policy Assignment Paper

Nursing organizations with legislative departments provide analysis on current issues in health policy and tips on how to communicate with legislators. Many also offer workshops on nursing advocacy, or legislative days at the state house, both excellent places to begin an advocacy career. You also could form a mentor relationship with an experienced nurse advocate, or seek formal education on health policy or public health. An internship with your local or state representative to work on health-related legislation helps you understand how the system works and gain networking contacts.

Here are some other tips and strategies:

Evidence-based practice is the gold standard for what we do. Evidence is also needed for nursing advocacy. Through research, gather a good base of evidence to present to decision makers about the changes you want to see.1 Be aware of limitations in studies you’re presenting because other interest groups may try to find flaws in the evidence.2
Don’t underestimate the power of personal experiences. Speaking to decision makers about personal stories puts a face and a story to an issue. Politicians also want to hear how legislative issues would affect their constituents.Advocate for Health Care Policy Assignment Paper
Use your local and state resources or national nursing advocacy groups to gain an understanding of current issues and learn how you can become involved. Many specialty nursing organizations have policy experts available as resources to beginning nurse advocates. They can help with preparing written or oral statements for hearings and may accompany nurses to hearings at the local state house or even on Capitol Hill.
Network with other nurses to create a unified voice. Equally important, form a good working relationship with your elected representatives and their staff by first building credibility with them.3 Working with your elected representatives on smaller nursing issues related to your experience builds credibility so they’ll be more likely to turn to you when they’re looking for resources for larger nursing issues.

Do you really want someone who isn’t a nurse (or who isn’t getting input from a nurse) deciding how nurses do their jobs? Nurses need to have their voices heard! Not everyone can become a full-time nurse advocate, but with even a small time commitment, it’s easy to become involved.

DNPs Influencing Health Care Policy

The medical industry relies upon healthcare policy to improve patient care and further healthy outcomes. Nurses are in the unique position to not only provide that patient care but to also influence that care’s policy.Advocate for Health Care Policy Assignment Paper

The American Association of Colleges of Nursing (AACN) has stressed the importance of nurses learning about and engaging in health care policy. “Health care policy — whether it is created through governmental actions, institutional decision-making or organizational standards — creates a framework that can facilitate or impede the delivery of health care services or the ability of the provider to engage in practice to address health care needs,” the AACN says. “Thus, engagement in the process of policy development is central to creating a health care system that meets the needs of its constituents.”

RNs who have earned a Doctor of Nursing Practice (DNP) degree have an opportunity to make a difference in healthcare policy. The nursing curriculum offered in Duquesne University’s online DNP program positions nurses as drivers of innovation. Graduates can use the skills and knowledge they acquire to transform policy in the healthcare field.

How DNP Programs Prepare Nurses for Careers in Health Policy

Nurses engaged in healthcare policy development can contribute to the creation of a healthcare system that benefits all constituents, according to Doctor of Nursing Practice DNP.org. Nurses who hold a DNP degree often have the most success at influencing healthcare policy because of the skills learned as part of their curriculum.

“While master’s-level APRN programs prepare students to function as effective clinical practitioners, most do not provide them with the skills and knowledge required to develop health policy or influence the political process,” writes the website. “Instead, it is the DNP that has become the primary source of education for nurses as it relates to healthcare policy.”Advocate for Health Care Policy Assignment Paper

The curriculum found in an accredited DNP program, writes the AACN, prepares the graduate to:

Critically analyze healthcare policy and related issues from the perspective of patients, nurses, and other stakeholders in policy and public forums
Demonstrate leadership in the creation of institutional, local, state, federal or international healthcare policy
Influence policymakers through active participation on boards or task forces at any level
Educate others regarding nursing and patient care outcomes
Advocate for nursing within healthcare communities
Develop, evaluate and provide leadership for policy that shapes healthcare regulation, financing and delivery
Lobby for equity, social justice and ethical policies in all healthcare arenas

Students in a DNP program gain insight into the impact of healthcare policy on all levels and its influence on the healthcare system.

“DNP graduates possess the tools to make changes in our society,” writes Marlene H. Mullin in DNP Involvement in Healthcare Policy and Advocacy. While DNP graduates gain both knowledge and education through the program, they also earn “practice experience, leadership skills, and knowledge regarding research and evidence-based practice, which allows them to be powerful advocates for healthcare policies.”

Further ways DNP students have advanced their healthcare policy experience include incorporating the study of that policy into their scholarly project. Students may also complete a policy fellowship after completion of a DNP program. During the fellowship, DNP nurses have the chance to interact with legislators on healthcare issues and attend hearings and conferences.Advocate for Health Care Policy Assignment Paper

DNP programs provide students with exposure to the political process and show them how that knowledge can be used in relation to health policy, writes Doctor of Nursing Practice DNP.org. RNs with a DNP can then seek out ways to apply their knowledge toward valid contributions to healthcare policy.

Avenues for DNP Involvement in Healthcare Policy and Advocacy

Upon completion of the program, there are several ways DNP-prepared nurses can become involved in healthcare advocacy. From joining a professional organization to influencing research, these are the ways DNP program graduates can use their experience to influence healthcare policy.

Join a professional nursing organization: Participation in a specialty nursing organization is critical for DNP graduates, according to Mullin. These types of organizations provide nurses with a forum when healthcare issues are being discussed and proposed. They also provide frequent updates on healthcare legislation via member newsletters or websites.
Lobby for change in the workplace: DNP graduates can use their leadership skills to influence and facilitate change in the workplace. They can advocate for improved procedures that affect patient care or serve as catalysts to implement new policies based on research and evidence-based practice.
Create effective patient education material: The education and clinical experience of DNP graduates allow them to be highly qualified disseminators of patient education material. Working as an advocate for patients, DNP graduates can develop and provide evidence-based education material that is both culturally relevant and sensitive.Advocate for Health Care Policy Assignment Paper
Participate in influential research: DNP graduates can apply research-based knowledge to participate in research studies that influence health, organizational and social policies regarding patient care and outcomes.
Become involved in politics: The leadership skills obtained by DNP graduates make them “excellent candidates for public offices,” writes Mullin. A position in public office allows DNP graduates to gain visibility so they can educate politicians and the public regarding the role of nursing. 
Avenues for DNPs to Influence Healthcare Policy

As DNPs become more comfortable with their role in healthcare policy, three key areas where they tend to find the most success are:

Coalition Building: Defined as an “effective approach to obtaining legislative and regulatory approval for an organization’s policy agenda,” coalition building occurs when nursing organizations ally with each other or with other healthcare groups, writes Mullin. RNs who have earned a DNP can serve as coalition leaders or organizers, often helping the groups to stay on target.Advocate for Health Care Policy Assignment Paper
Policy Intervention: The knowledge and skills RNs gain in a DNP program makes them “prepared, informed and empowered to support a healthcare policy that aims for safe, effective, patient-centered, timely, efficient and equitable care,” Mullin notes. They can provide expert testimony, serve as experts on the policy’s content and lobby legislators for support of the intervention.
Legislation Evaluation: Nurses with DNP degrees can assess the potential for legislation’s success or failure by formally evaluating the policy. Questions they might ask include: What political obstacles lie ahead for implementation? How will outcomes be measured? Is the plan sustainable?

DNP graduates who use their education and knowledge in these areas have the greatest ability to become influential healthcare policymakers.

A DNP’s Role in Health Policy Efforts

In Virginia, our legislative session ended two weeks ago. We have made some subtle progress in our move to full practice authority, but we still have many challenges. Our task is now to regroup and to plan a path forward in preparation for the next legislative session.

Nurses at all levels should be prepared to engage in healthcare policy and advocacy.1 However, nursing is under-represented in our political landscape. There are currently only six nurses elected to Congress,2 but 20 physicians currently serve in Congress.3 There are more than 2.7 million registered nurses working in the United States4 and 894,000 physicians.5Advocate for Health Care Policy Assignment Paper

With the advent of the Affordable Care Act in 2010, 16 million Americans have gained healthcare coverage.6 This has created a greater need for healthcare leaders with the knowledge, skills and abilities to not only provide healthcare for additional individuals, but to ensure that healthcare policies address the population health needs and cost as well as the patient experience. DNPs are perfectly poised to be health policy leaders. But how is that achieved?

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First, we must all be familiar with the basic political structure. Remember the Executive, Judicial and Legislative Branches of government you probably first learned in elementary school? We will focus on the Legislative Branch for this discussion. Recognizing your elected officials and having a basic understanding of the legislative process is the first step in understanding health policy and being an effective advocate. Each state has a website dedicated to the legislative branch where you can look up your legislators if you do not know their names or contact information. For our Congress, simply go to: House.gov and Senate.gov. Each has a link to find your Representative or Senator.Advocate for Health Care Policy Assignment Paper

Second, the DNP needs to be able to identify opportunities to assess, design, evaluate and implement health policy based on the current healthcare and legislative landscape. Effective and politically competent advocacy efforts will result in the greatest improvement in healthcare delivery and nursing’s role in healthcare redesign. Grassroots advocacy can be a very effective way to identify and create a politically active base that has the power to inform and influence health policy.

Finally, identifying experiential learning opportunities for the nurse to actively engage in healthcare policy, politics and advocacy is essential to position the nurses as leaders in healthcare reform and improved patient outcomes. As DNPs, we can be leaders in completing Health Policy Fellowships, actively seeking opportunities to gain a seat at the table through appointments to Governor’s task forces and coalitions, and continuing to be politically aware through participation in advocacy efforts in our state and national organizations. Mentoring nurses new to advocacy can be another easy way to gather a small group of people to work together for a common goal.Advocate for Health Care Policy Assignment Paper

Nurses are in every healthcare setting and are integral to healthcare delivery and outcomes. Empowering the nurse advocate to assess, plan, implement and evaluate healthcare policy will improve the Triple Aim7 and improve access to care to reduce health disparities. All nurses should be ready “to participate as a nursing professional in political processes and grassroots legislative efforts to influence healthcare policy.”1

Nursing education programs at the doctoral level recognize that advanced practice nurses are uniquely qualified to develop, implement, and evaluate health policies. Through a Doctor of Nursing Practice (DNP) program, students learn the meaning and importance of health policy and advocacy. DNP graduates are therefore armed with the skills to become leaders and political advocates who advance their own practice and protect the welfare of their patients.Advocate for Health Care Policy Assignment Paper

Thanks to the integration of health policy curricula in DNP programs, interest has piqued among nurse practitioners and other advanced practice registered nurses interested in influencing healthcare reform, promoting global health, and contributing something of value to the nursing profession.

Thanks to their extensive clinical background and their knowledge of health policy issues, today’s DNP-prepared APRNs have an excellent working knowledge of the language of legislation and regulation and are well positioned to influence the content and quality of healthcare policy.

The Unique Contributions DNP-Prepared Nurses Bring to Healthcare Policy

There are a multitude of ways DNP nurses can engage in the process of transforming healthcare and influencing the health policy agenda. At the novice level, APRNs may start their journey by reviewing literature and analyzing health policy research. This early stage lends itself well to developing an awareness and understanding of the issues, making this the first real meaningful step towards influencing the ways in which healthcare is organized, paid for and delivered.

As they become more comfortable and knowledgeable about the process, DNP-educated APRNs may move on to make significant contributions to health policy by engaging in:Advocate for Health Care Policy Assignment Paper

Coalition Building

Coalition building is an effective approach to obtaining legislative and regulatory approval for an organization’s policy agenda. Nursing organizations often form coalitions, either with each other or with other healthcare organizations. DNP nurses serve as the leaders of these coalitions, organizing the work of the coalition, and motivating the group to stay on target.

Policy Intervention

DNP nurses also have the ability to address policy intervention. Through their advanced knowledge and skills, they are prepared, informed, and empowered to support a healthcare policy that aims for safe, effective, patient centered, timely, efficient, and equitable care. Through their work in health policy, DNP nurses provide expert testimony, serve as content experts, and garner support from legislators during the process.

According to The Doctor of Nursing Practice Essentials (3rd Edition, Zaccagnini and White), health policy is not just a legislative process but also a comprehensive method of identifying healthcare issues and then bringing those issues to the legislature and to the American public.

DNP nurses develop policy agendas, embrace their core values, and learn the skills involved with making and influencing policy. Together, nurses make up the largest contingent in the healthcare system. This puts the nursing workforce in the unique position of being able to influence healthcare reform by offering guidance and support to elected leaders.Advocate for Health Care Policy Assignment Paper

Legislation Evaluation

DNP nurses assess the success or failure of legislation through a formative evaluation of the policy process, answering such questions as: What were the political obstacles to policy legislation and implementation? How will the outcomes be measured? Is this plan sustainable?

As the content of policy education is formalized within DNP programs, it is up to educators to demonstrate the relevance of policy in practice, including instructing APRNs on how to determine the basis for proposed policy changes.

How DNP Programs are Uniquely Well Suited for Preparing Nurses for Careers in Health Policy

According to the American Association of Colleges of Nursing (AACN), health care policy creates a framework designed to facilitate the delivery of healthcare services and enable providers to engage in practices that addresses the healthcare needs of the public. Regardless of whether healthcare policy is created through governmental actions, institution decision making, or organizational standards, nurses engaging in policy development contribute to creating a healthcare system that meets the needs of its constituents.Advocate for Health Care Policy Assignment Paper

DNP-educated nurses in health policy are also leading the discussion around increased autonomy for advanced practice registered nurses and removing legal barriers that prevent them from practicing to the full extent of their training and education.

While master’s-level APRN programs prepare students to function as effective clinical practitioners, most do not provide them with the skills and knowledge required to develop health policy or influence the political process.

Instead, it is the DNP that has become the primary source of education for nurses as it relates to healthcare policy. For example, the National Organization of Nurse Practitioner Faculties (NONPF) identifies the following competencies for DNP graduates:

Analyze legal, ethical, and social factors in policy development
Evaluate the globalization on the development of healthcare policy
Influence health policy

Program content in a DNP program focuses on the significance of healthcare policy on all levels—state, national, and international—and how it influences healthcare systems. Often times, students of DNP programs further study health policy by incorporating the topic into their scholarly project.

Field experiences in DNP programs may include visiting elected officials, spending time with an administrator, communicating with a national leader, or contacting a community-based action group. Doing so allows students to work alongside mentors who are knowledgeable about health policy. Many students also seek out faculty or healthcare leaders who are actively involved in advanced practice nursing issues.Advocate for Health Care Policy Assignment Paper

Many times, APRNs interested in influencing legislation and serving as health policy experts complete a policy fellowship after completing their DNP. Policy fellowships provide DNP nurses with the opportunity to brief legislators on healthcare issues, develop proposals, and attend staff hearings and conferences.

DNP programs provide students with valuable exposure to the political process and opportunities to apply their newly gained knowledge as it relates to health policy.

Importance of Patient Advocacy in Nursing

An advocate is someone who serves as a supporter, partner, friend, confidante, cheerleader and more. Nurses wear all of these hats at one time or another — sometimes all for the same patient. Advocacy is as essential to the role of a nurse as any other aspect of nursing care. Interacting with patients more than any other healthcare provider, nurses are in the perfect position to serve as patient advocates. Nurses use a number of techniques and follow many principles to be excellent patient advocates.

Nursing Code of Ethics

Nurses must adhere to the Code of Ethics of the American Nurses Association (ANA), which addresses the issue of patient advocacy in nursing. That advocacy involves supporting patients in many ways.Advocate for Health Care Policy Assignment Paper

Healthcare Equality for All Patients

According to the Code of Ethics, all nurses must care for patients “with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems.” Everyone should have equal access to healthcare, and all nurses should adhere to the principle of universal human value.

Nurses have a responsibility to advocate for equal access to care. Everyone deserves access to the same level of attention and compassion. Race, religion, socioeconomic status or other criteria should not be a factor in healthcare. Nurses can and should advocate for healthcare equality. They should encourage others not to discriminate and model this principle themselves.

Alleviation of Suffering

Sadly, there is a great deal of suffering that occurs in the healthcare setting. As their patient’s advocate, nurses have a responsibility to address their suffering. Nurses need to observe each patient and assess their level of discomfort because suffering is relative. There are two categories of suffering: the illness, disease, injury, diagnoses or treatment and problems caused by the healthcare system, such as medical errors.

Some of the areas where nurses can advocate for their patients include pain management and reducing physical suffering. Nurses can also address mental, psychological or emotional suffering.Advocate for Health Care Policy Assignment Paper

Promotion of Human Dignity

Paying attention to and preserving human dignity includes maintaining the patient’s autonomy, respect and privacy. Nurses must abide by patients wishes regarding healthcare choices, and nurses must also remind patients that they have control over their bodies and their care.

Nurses can respect patients by not talking down to them, literally or figuratively. When it comes to privacy, nurses can discuss private matters discreetly. Respecting modesty is another way nurses can be conscientious.

Techniques for Implementing Advocacy

What does patient advocacy look like in practice? The following are some examples of advocacy techniques and strategies:

Have the information patients need or know how to obtain it.
Present necessary information to patients clearly, concisely and in terms they can understand.
Respect people’s wishes even when they conflict with our own.
Stay objective at all times.
Encourage patients to make their own choices about their healthcare.Advocate for Health Care Policy Assignment Paper

Advocacy in nursing is very important for quality care and patient satisfaction. Always strive to be the best advocate you can. We owe our patients and their loved ones nothing less.

As health care systems continue to evolve, patients are relying more and more on guidance from nursing advocates.

People who are unfamiliar with the term may wonder, “What is nursing advocacy?” and “What can it do for me?”

Advocacy as defined by Merriam-Webster is “the act or process of supporting a cause or proposal.” Nursing advocacy goes one step further and designates the “cause” to be a patient and their rights.

An interpretive statement on Provision 3 of the Code of Ethics for Nursing states it best: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.”

5 Tips for Better Nursing Advocacy

Incorporate these five nursing advocate strategies into your daily routine to become a better advocate for your patients.

1. Communicate Effectively

Nursing advocates need excellent verbal, written and electronic communication skills. Hospitals are bustling, and your coworkers are pressured. If you have a concern, state it concisely, and stay on topic.

The Online Journal of Issues in Nursing has a template for a 60-second speech designed to get your problem noticed.

2. Understand Nursing Advocate Laws and Regulations

You need to be familiar with state and federal laws along with your hospital’s policies and procedures. In your role as a nursing advocate, you may find yourself ignored or even harassed. Advocate for Health Care Policy Assignment Paper

How far are you willing to go for your patient’s rights? The Nursing Advocacy Association recommends all nurses understand the Safe Harbor provision within their state.

3. Maintain a Positive Relationship with your Health Care Team

If you’re known on the floor as the short-tempered, self-seeking busybody, it’ll be hard to get support as you fight for patient’s rights.

Your relationship with associates affects the response your patient receives if problems arise. Keep your attitude cheerful, and learn how to deal with negative coworkers.

4. Focus on Practice Improvement

A nursing advocate should try to enhance a patient’s care experience. Hospital processes are constantly changing; your suggestions and creativity should revolve around helping your patients.

5. Be Available to Patients and their Families

Although documentation takes time, it’s still the bedside care that distinguishes a valuable nurse. Your relationship with patients and family members opens the door to frank discussions. Advocate for Health Care Policy Assignment Paper

This provides you with the opportunity to mediate any problems between the doctor’s plans and the patient’s goals.

A nurse is often the final link in the health chain of command. You’re the one on hand when a patient takes their medication, undergoes a procedure or experiences a change in their condition.

It’s your responsibility to act for your patient as a nursing advocate.

Reflect for a moment on your professional and personal interests. What causes, issues, or areas of need really matter to you? What positive outcomes in global health and the communities you serve do you want to help advance? For what do you want to advocate? What knowledge and expertise do you need to be effective in your advocacy?

Influence involves advocacy, and to be effective in advocating for change and better outcomes for individuals, communities, and society at large, we need to be engaged. Influence can be understood as the power to cause change, preferably change that positively affects others or advances an important issue. Credible leaders influence others to be the best they can be in whatever they are doing. In nursing, we “jump ship” to follow leaders who inspire and influence us to achieve the best outcomes for those we serve (Hofmeyer, Sheingold, Klopper, & Warland, 2015).Advocate for Health Care Policy Assignment Paper

Advocacy is active support of a cause. Through effective use of strategies and methods that influence views, choices, and—most importantly—actions of individuals, communities, or organizations, we address areas of need. Advocacy can be understood as standing up and speaking out for a moral good, voicing concerns of disadvantaged people, and collaborating with individuals or groups who need support in exerting their rights and preferences.

Nursing has a long tradition of advocacy for the common good. Florence Nightingale advocated for better hospital conditions for patients in the Crimean War and better education for nurses. She sought to influence governments, policymakers, physicians, and philanthropists as she advocated for continuous improvement in health conditions and better care of the sick and vulnerable. She observed, “Were there none who were discontent with what they have, the world would never reach anything better.”

It is up to us, members of STTI, to identify the causes, issues, or areas of need that matter to us and discern how, through advocacy, we can effect influence that raises awareness and advances change.Advocate for Health Care Policy Assignment Paper

What matters to me?
I advocate for a palliative care approach to become mainstream in global health systems. This means that any patient with a life-limiting illness (regardless of diagnosis) will have access to health care that is responsive to their holistic needs, promotes quality of life and hope, and is provided by inter professional teams. No longer should access to palliative care be limited to patients with cancer or be available only to patients who are admitted to hospice and palliative care units.

Early in my nursing career, I became engaged in improving access to palliative care because I could not relate to—or promote—the values of a health system that ignored and marginalized patients who could not be cured. I saw neglect of patients who suffer with life-limiting illnesses (and their families) as unjust and indefensible. In 1967, Dame Cicely Saunders, OM, DBE, FRCS, FRCP, opened St. Christopher’s Hospice in London. Her approach to pain and symptom management became the foundation for hospice and palliative care practice. She explained the complexity of suffering and the need for emotional, psychological, and spiritual support for the terminally ill patient as well as his or her family.

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psycho social, and spiritual.” Palliative care aims to comfort, not to cure; to relieve pain and distress; improve the quality of life for people with a life-limiting illness and their families; and support families in bereavement. Therefore, it is crucial to advocate for targeted education of nurses and inter professional teams and palliative care access that is inclusive of patients with non cancer diagnoses, such as heart failure, dementia, chronic obstructive pulmonary disease, motor neuron disease, and multiple sclerosis.Advocate for Health Care Policy Assignment Paper

What matters to you?
On 1 January 2016, the 17 Sustainable Development Goals (SDGs) of the United Nations’ 2030 Agenda for Sustainable Development were officially launched. Relevant for developing as well as developed countries, the goals are reflective of the view that health is socially determined, that it is influenced and experienced within a social context. For that reason, there is synergy between the diverse SDGs.

For example, achievement of Goal 3 (good health and well-being) is dependent on advancing goals to build just and inclusive civil societies and to develop sustainable social and environmental resources. As nurses seeking influence to advance global health and nursing, it is useful for each of us to decide, within the context of the SDGs, what causes, issues, or areas of need are the best “fit.” Finding a fit between one or more SDGs and our individual areas of advocacy will strengthen our influence, relevance, and achievements.

In addressing the area of advocacy you choose, what evidence do you need to consider in your decision-making? What actions have worked in similar communities to address similar causes or issues, and what, therefore, may be a sound course of action for you to adopt? Answers to questions such as these will help you decide how to engage in advocacy that leads to positive outcomes for those you serve.Advocate for Health Care Policy Assignment Paper

Human capital can be understood as the values, knowledge, and expertise of individuals who, by working cohesively with others, can foster productive networks and relationships (social capital) to achieve common goals, such as quality healthcare (Hofmeyer, 2013). When we act to foster productive networks and relationships, evidence-based healthcare, and “good health and well-being for all” (SDG 3), we also promote “just, peaceful, and inclusive societies and institutions” (SDG 16) where people feel respected and hopeful, regardless of their diagnoses or social context.

Are you ready to influence through advocacy?
To build capacity for influence through advocacy, President Catrambone suggests that we, as nurses, embrace three strategies to guide our actions: 1) Develop advocacy expertise, 2) engage in advocacy, and 3) foster advocacy partnerships.
Advocacy means leveraging one’s position to support, protect, or speak out for the rights and interests of others. Long before the American Nurses Association (ANA) defined nursing as including advocacy in the care of individuals, families, communities, and populations, the nurse’s role as advocate had been well established by nurses throughout history.

While Florence Nightingale did not directly name advocacy as a nursing responsibility, her actions and writings consistently focused on advocating for change. Lillian Wald and her nursing colleagues advocated for care of immigrants on New York’s Lower East Side, which led to the establishment of the Visiting Nurse Service. Early ANA founders sought formation of state nurses associations to create standards for the practice of nursing, resulting in nurse practice acts.Advocate for Health Care Policy Assignment Paper

While nurses embrace the advocacy role for patients, the expectation for advocacy on behalf of one’s nursing colleagues, the profession, and even one’s self is less clear and not necessarily the norm. This area of policy development has traditionally been one of the slowest to advance in nursing, according to a 2011 report from the World Health Organization on strengthening nursing and midwifery services. All too often, nursing’s role has been to implement policies and programs rather than to participate in and bring the nursing perspective, experience, knowledge, and skills to policy formulation and healthcare planning.

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As the largest group of health professionals in America, and consistently the highest ranked for ethical behavior by the public, nurses are in a unique position to influence the direction of both the profession and health care. (Nurses professional responsibilities to work with colleagues to promote safe practice environments are described in ANA’s foundational documents, including Nursing: Scope and Standards of Practice [2015] and Code of Ethics for Nurses with Interpretative Statements [2015].)

In keeping with this tradition, ANA has declared 2018 as the Year of Advocacy. You are invited to exercise your influence to shape and bring about change, both at the bedside and beyond. Nurses contribute professional expertise in every setting and at every level of care delivery and policy development. Throughout the year, ANA will feature examples of nurses engaged in a variety of advocacy efforts. Issues for advocacy can be global or local, including environmental health, human trafficking, health inequities, emerging infectious diseases, or distributional of the healthcare workforce. Removing barriers to scope of practice, reducing incidents of workplace violence, and implementing safe nurse staffing policies are initiatives that dominate ANA’s and many state nurses associations agendas. Additionally, the call to serve on boards allows nurses to provide a unique perspective to promote change and advance health, as noted in a 2016 article by Stalter and Arms in OJIN: The Online Journal of Issues in Nursing. Nurses also serve in state legislatures and Congress, bringing their distinctive leadership, analysis and communication skills. The possibilities are limitless. Nurses often say they’re not involved in advocacy beyond the bedside due to time constraints or not knowing where to begin. With this in mind, ANA will offer strategies and tools for being an effective advocate in whatever capacity you choose, including in-person and digitally based opportunities to get educated and get involved. Knowledge, as we know, is power; it begins here. We look forward to sharing more about the Year of Advocacy in 2018, and embracing the opportunity to make every subsequent year one in which advocacy is at the top of ANA’s and every nurse’s agenda.Advocate for Health Care Policy Assignment Paper

Advent Health has a deep and abiding respect for our patients and their rights. As a patient you have the right and responsibility to be informed and participate in every decision that involves your care and treatment. If you are unable to do so, then your rights can be legally transferred and exercised by someone that you designate to make decisions for you when you are temporarily incapacitated. State law requires that your physician and our facilities recognize your rights while you are receiving medical care and that you understand our rights in return to expect a certain behavior on your part as a patient. We’re more than happy to provide you with the full text of the laws regarding patient rights and responsibilities.

This notice about Patient Rights and Responsibilities applies to Advent Health and:

Any health care professional authorized to enter information into your medical record maintained by an Advent Health facility, such as doctors, nurses, physician assistants, technologists and others.
All departments and units of Advent Health facilities, including hospitals, outpatient facilities, physician practices, skilled nursing facilities, home health agencies, hospices, urgent care centers, and emergency departments.
All employees, staff, students, volunteers and other personnel of Advent Health facilities. Advocate for Health Care Policy Assignment Paper
Patient’s Rights

As a patient, you have the right to:

Impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap or source of payment.
Treatment for any emergency medical condition that will deteriorate if treatment is not provided.
Know who is providing medical services and who is responsible for your care.
Request notification of a family member or representative and your own physician(s) promptly upon admission to an Advent Health facility.
Be given information by Advent Health or your physician(s) concerning your diagnosis, health status, planned course of treatment, alternatives, risks and prognosis.
Be informed about the outcomes of care, treatment and services that have been provided, including unanticipated outcomes.
Assessment and management of your pain.
Request and refuse any care, treatment or services, except as otherwise provided by law.
Formulate Advance Directives and have your physician(s) and Advent Health facility staff provide care that is consistent with these directives.Advocate for Health Care Policy Assignment Paper
Prompt and reasonable responses to questions and requests.
Be free from both physical restraints and drugs used as a restraint, except when necessary and or when less restrictive interventions have been determined to be ineffective.
Be treated with courtesy and respect, with appreciation of your individual dignity in an environment that contributes to a positive self-image.
Be free from mental, physical, sexual and verbal abuse, neglect and exploitation.
Protection of your need for privacy and to receive care in a safe setting.
Confidentiality of your health information.
Access to information contained within your medical record within a reasonable time frame.
Know what rules and regulations apply to your conduct.
Know what patient support services are available, including whether an interpreter is available if you do not speak English.
Access protective and advocacy services.
Know if medical treatment is for the purpose of experimental research and to give your consent or refusal to participate in such research.
Be given information and counseling on the availability of known financial resources for your care upon request.
To know upon request and in advance of treatment, whether the Advent Health facility or your physician(s) accepts the Medicare assignment rate.
Receive, upon request and prior to treatment, a reasonable estimate of charges for medical care.Advocate for Health Care Policy Assignment Paper
Receive a copy of a reasonably clear and understandable itemized bill, and upon request, have charges explained.
Have the Advent Health facility or your physician(s) address you or your family’s concerns or complaints about your care or services provided.
Express grievances regarding any violation of your rights as stated in your state’s law, through the grievance procedure of Advent Health or your physician(s) and to the appropriate state licensing agency.
Patient Responsibilities

As a patient you are responsible for:

Providing Advent Health and your physician(s), to the best of your knowledge, accurate and complete information about present complaints, past illnesses, prior hospitalizations, medications and other matters related to your health.
Reporting unexpected changes in your condition to Advent Health and your physician(s).
Reporting to Advent-health and your physician(s) whether you comprehend a contemplated course of action and what is expected of you.
Following the treatment plan recommended by Advent Health or your physician(s).Advocate for Health Care Policy Assignment Paper
Keeping appointments and, when you are unable to do so for any reason, notifying Advent Health or your physician(s).
Taking responsibility for your actions if you refuse treatment or do not follow the instructions from Advent Health or your physician(s).
Assuring that the financial obligations of your healthcare are fulfilled as promptly as possible.
Following Advent Health facilities rules and regulations affecting patient care and conduct.

The Healthcare Advocate program brings a complete solution for a Quality Student Health Insurance program. This solution is set apart by the assignment of a dedicated Healthcare Advocate. Your Advocate maximizes the benefits of your student insurance program. Your students have a resource who can answer their questions, check on their claims and provide appeal services in the event a student has a claim denied by the insurance company.Advocate for Health Care Policy Assignment Paper

We become your full-service Satellite Office of Student Insurance, just as if we were down the hall. When a student approaches you with a student insurance question, you provide them your dedicated toll-free telephone number. Our Healthcare Advocates are experts in your student insurance policy and can educate your students on your school-sponsored plan. If a specific question arises, our Healthcare Advocates have access to back-office staff at the insurance company to get the answers efficiently.

Our technology provides a customizable website for the collection of enrollment data and/or waivers. Our proprietary software tracks each student through the process.

This is a fee-based program. The fee is added to the cost of insurance paid by the student. This payment arrangement assures our Healthcare Advocates remain conflict-of-interest free and enjoy the freedom to work on behalf of your students. The Healthcare Advocate Program is best suited for hard waiver, soft waiver and modified waiver programs.Advocate for Health Care Policy Assignment Paper

Services Include:

Healthcare Advocacy
Request for Proposal Services
Enrollment/Waiver Processing
Mailings and Phone Calls
Direct Premium Collection
Reporting and Auditing
Athletic Reporting

Healthcare Advocacy
For most 18- to 23-year-old college students, the college experience is the first time they will be dealing with healthcare issues on their own. It is important to provide support services to students assisting them with the complex task of understanding and effectively utilizing their insurance benefits.

Students who have enrolled in the school-sponsored plan can turn to your dedicated Healthcare Advocate to answer benefit related-questions, find an in-network provider, and interpret the Explanation of Benefits from the insurance company. Your Health Center can refer off-campus medical providers to the Advocate for questions about specific coverage’s or referral procedures under the school-sponsored plan.Advocate for Health Care Policy Assignment Paper

Occasionally, our Advocates find errors in billing by the providers or payment of benefits by the carrier. Your Advocate will take the responsibility of the in-depth analysis of the problem, follow the paper trail to place where things got off track, and work with the appropriate entity to have the problem corrected. All on behalf of your students!

We run into special situations where the insurance company unreasonably denies a claim. Your Healthcare Advocate will research through the policy to find areas of coverage and author the written appeal to the Carrier, including coordinating submissions from medical providers. The Healthcare Advocate will follow the process through to a final decision by the carrier. In 2008, our Healthcare Advocates authored 20 appeals and was successful in gaining additional medical insurance benefits for 14 students, with one appeal still pending.

The increasing number of elderly people in the U.S. population poses a variety of public policy challenges. Not the least among them is the implementation of a strategy that provides long-term care in a cost-effective manner that is sensitive to the medical and social needs of older Americans. Answers to these questions will not come easily. Indeed, the Reagan administration and Congress chose to essentially ignore them as they moved to approve a new Medicare benefit that will provide elderly beneficiaries greater protection against the economic consequences of acute illness. The one essential reason for this failing? Long-term care benefits are too expensive and their projected future cost too difficult to predict. In this essay, sociologist David Mechanic outlines a strategy for long-term care that supports community participation and reinforces the informal care and support that already exist.Advocate for Health Care Policy Assignment Paper It stresses that Medicaid should include protection against catastrophic illness but that this is only part of the solution. A strategy of long-term care is required that makes it possible for the elderly to obtain care without first becoming destitute. Overall, the challenge of long-term care is to develop a viable financing structure that is within a meaningful community context and consistent with efforts to sustain voluntary long-term care efforts. Mechanic is director of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, where he formerly served as dean of the Faculty of Arts and Sciences. An active member of the National Academy of Sciences’ Institute of Medicine, Mechanic is the author of numerous books and articles, including three previous papers in Health Affairs.
The Implications Of Aging For Health Care Planning

The health status of varying birth cohorts as they approach the later years reflects a broad history of personal habits and environmental influences throughout the lifespan. There is indication that successive cohorts at different ages in middle and later life are more healthy, possibly a product of improved living conditions during their development or a result of positive health behavior that reduces exposure to risk factors. Aggregate data on health status and illness by age are not particularly informative because the inclusion of persons whose mortality is reduced or delayed through sophisticated medical measures inflates aggregate overall rates of illness and disability, which may mask other improvements in health status in the population. 6 Increased longevity of elderly populations with serious chronic illness, however, poses serious challenges for the provision of medical and other long-term care services. As individuals move into the eighth and ninth decades of life, the probability of decreased function, dependence on others, and risk of institutionalization substantially increases. Thus, the number of individuals at risk, while only a small portion of those over sixty-five, is a relatively large segment at age eighty-five. 7

Long-term care for the elderly is substantially rationed by the abhorrence many elderly have for residence in nursing homes. Persons who could meet any reasonable criteria for nursing home admission hang on with the assistance of family, friends, and neighbors to avoid entering institutions. The trigger for admission is often not the level of need alone, a criterion that could be met by many living outside nursing homes, but rather the loss of a spouse or other significant supportive persons or a major illness or accident that makes persons lacking supports unable to care for themselves.Advocate for Health Care Policy Assignment Paper

There is a perversity about a system of care that depends for its equilibrium on public abhorrence. Those elderly with significant needs for care greatly outnumber those in nursing homes. For many such patients, home and community care are preferable, and in the individual instance, economical as well. But shifting services to the community removes the barrier of abhorrence, opening increased demand that promises aggregate long-term care costs in excess of current expenditures. Herein lies the dilemma and the challenge that a prudent and humane public policy must address.

Policy Issues At The Federal Level

Cost-containment pressures affect government programs acutely because the federal government pays a large proportion of total health expenditures (28.9 percent in 1983), because health care costs constitute a significant component of the federal budget (over 12 percent in 1983), and because health expenditures make up even a larger proportion of the federal budget under administrative and legislative control. Given its magnitude and discretionary possibilities, it becomes an area of close scrutiny in times of budgetary constraint. Projections of the expected insolvency of the Medicare Trust Fund have been pushed forward as the economy has improved, but demographic realities will require us to reassess the future structure of Medicare, and to face the inadequacies of long-term care provision.Advocate for Health Care Policy Assignment Paper

Ideally, we seek a program that eases access to high-quality care among those who most need care; distributes entitlements in an equitable way; protects vulnerable individuals and their families against catastrophic costs; and shapes incentives for professionals, patients, and caretakers to promote improved function and rehabilitation efforts. Notwithstanding the ambiguity of such terms as access, quality, need, and equity, it seems clear that in addition to Parts A and B (hospital costs and physicians services, respectively), as currently constituted, Medicare should include protection against catastrophic acute care costs. But this is only a small part of the problem. A strategy for long-term care is required that makes it possible for the most needy to obtain care without first impoverishing themselves or their families, a common occurrence in many jurisdictions under Medicaid regulations. Medicare costs cover only 44 percent of health care costs of the elderly, and recipients now contribute a larger proportion of income out-of-pocket than they did prior to 1966 when the program was implemented. In some subgroups, such expenditures exceed acceptable levels of total income. 8

The responsibility of the elderly.

As we examine ways of reducing cost sharing for those with least income, there is also merit in examining carefully the capacity of some elderly to take responsibility for greater costs as a way of protecting and enhancing the benefit structure. Alternative approaches include taxing the value of the Medicare benefit among recipients whose incomes exceed a defined ceiling, eliminating other preferences to the high-income elderly such as the additional tax deduction, or taxing more Social Security income above a specified income level. Means testing is increasingly suggested but would alter the program irrevocably. The beauty of Medicare is its universality and its acceptance and support across all social groups in the population. Unlike Medicaid, it is not a welfare program and is immune to the stigma and distrust commonly associated with the Title XIX program.Advocate for Health Care Policy Assignment Paper

The obvious needs to address catastrophic costs and to plan more appropriately for long-term care would suggest greater dependence on general revenues. In the context of a large deficit, an ideology supporting the contraction of the federal government, and resistance to increased taxes, this is no easy matter, and identifying ways to reduce program expenditures will continue to be the main emphasis of public policy. In the absence of increased revenues, there are four general alternatives: changing eligibility criteria to reduce the pool of beneficiaries, increased cost sharing, continued tightening of reimbursement, and modifying the benefit structure. Most of these alternatives are not desirable, but we probably will see efforts in all of these areas.

The problems of Medicare and Medicaid are not isolated issues but should be seen in the context of health subsidies in general. Recently, Enthoven estimated that the tax subsidy of health insurance benefits was almost $50 billion and likely to increase as a result of a recent Internal Revenue Service (IRS) ruling permitting health insurance premium contributions to be purchased with before-tax dollars when certain conditions are met. 9 While some subsidy encouraging health care insurance is defensible, existing subsidies have encouraged over insurance among the affluent, which, if we take the Rand Health Insurance results seriously, contributes little to improved health status but increases utilization and cost. 10

There is broad recognition of the inequity of this subsidy, but those who benefit from it have been effective in resisting its modification. Revision may be more feasible, however, within a framework that reallocates the subsidy to address such issues as catastrophic costs, long-term care, and the needs of the uninsured and those institutions that provide much of their care. Reducing a tax benefit to lower federal expenditures may be less compelling than devising a more equitable and acceptable framework for care overall. The latter, if well designed, could coalesce a range of influential constituencies that would potentially provide the necessary political momentum.Advocate for Health Care Policy Assignment Paper

The role of public financing.

A major challenge is to maintain the universality of Medicare, but in a context that offers broader protection against catastrophe and a mode of financing that protects low-income recipients from burdensome levels of cost sharing. The increased cost sharing in Medicare involving an inpatient deductible of $520 for each period of illness, a $75 deductible and 20 percent coinsurance for approved doctor’s charges, and heavy coinsurance for hospital stays exceeding sixty days results in devastating costs in individual instances. Approximately two-thirds of Medicare patients protect themselves by purchasing Mediated insurance that covers much of these costs, but such policies are expensive relative to the benefits provided because of marketing, administrative costs, and profits. Medicare could provide expanded benefits at no greater cost than the elderly now pay for Medigap protection. This approach was suggested by the Social Security Advisory Council, advocated by the Secretary of the Department of Health and Human Services, and is now being considered by Congress.

The 30 million Medicare recipients are a highly varied group, eco-nomically and otherwise. Disparities in income are large and tend to be underestimated, since affluent elderly receive a larger proportion of their resources from unearned income that is not fully reported. 11 A significant proportion of elderly have modest incomes (approximately half within 200 percent of the poverty line) but are not sufficiently destitute to be eligible for Medicaid. 12 Thus, health expenditures may usurp an intolerable proportion of their income, preventing them from fulfilling other needs. One approach to remedying the uneven result of cost sharing is to provide a tax credit to recipients whose out-of-pocket health expenditures exceed some reasonable proportion of income. Those whose incomes, in contrast, exceed specified levels could be taxed on the average value of the Medicare benefit.Advocate for Health Care Policy Assignment Paper

Much attention has been focused on efforts to tighten reimbursement under Medicare and the implementation and consequences of Medicare’s prospective payment system (PPS). The growth of physician payment under Medicare Part B has also stimulated a variety of measures to control physician payment, including a freeze on fee increases. (Payment to physicians increased 106 percent between 1979-83, almost three times the gross national product. 13 ) The unwillingness of many physicians to accept Medicare assignment puts the burden of payment on the elderly for charges beyond those allowable by Medicare. This can substantially inflate required out-of-pocket expenditures. Various proposals are being considered to encourage physicians to accept assignment, as well as mandatory assignment approaches. 14 There is concern that mandatory assignment would make physicians less accessible to the elderly, but, given the important contribution Medicare makes to physician income, the growing numbers of physicians, and the increasing competition for patients, it seems unlikely that many physicians would opt out of Medicare. Measuring the quality and responsiveness of care, in contrast, is more difficult, but fears about diminished attention to patients with mandatory assignment constraints, particularly in light of the increasing competitiveness of the arena, may be exaggerated.

Medicare’s PPS constitutes a stage in the evolution of a more comprehensive prospective payment system. On the one hand, more thought is being given to extending the PPS approach to other services such as nursing home payment and inpatient physician services. On the other hand, serious efforts are being made to enroll the elderly into capitated arrangements, such as health maintenance organizations (HMOs), in which the health entity assumes the risks of unanticipated costs. PPS, as it now operates, is simply a tool to control payments. We can anticipate increased efforts to refine diagnosis-related groups (DRGs) to control for complexity of care. Also, we can expect reduced payments as economic pressures in the program increase and better hospital performance data that justify modifications become available.

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Hospital and physician reimbursement policies reflect the need to control program costs and, it is hoped, to encourage efficiency, but processes of decision making within the hospital remain uncertain. It is not obvious that constraints result in wise decisions or that managers in hospitals have the authority to constrain physician behavior constructively. With the increased availability of physicians, managers have more options, yet their dependence on physician’s patients in a highly competitive situation has countervailing influences. We need a much better, more detailed understanding of how decisions are worked out in this context. Peer Review Organizations and other regulatory authorities, and the rapidity of change, add to the reasons to anticipate major gaps between theory about the internal responses of hospitals and reality.Advocate for Health Care Policy Assignment Paper

Strategies For Long-Term Care

In the absence of a national strategy for long-term care, and the exclusion of long-term services from Medicare coverage, Medicaid, by default, constitutes our national long-term care program, financing approximately half of national nursing homes expenditures. The cost of long-term care taxes the resources of most families, and typically elderly entrants to nursing homes on their own resources spend down until they reach eligibility for Medicaid. In the case of a family unit, however, the patient’s elderly spouse is commonly forced into poverty before eligibility is reached, a situation that shocks the conscience of the public. The problems of building a long-term care constituency are exacerbated by the common belief among the public that Medicare provides needed protection. Four-fifths of members surveyed by the American Association of Retired Persons, who thought they might require long-term care in the future, believed that all or most of the costs were covered by Medicare or private insurance.

Community-based care.

The goal is to develop an appropriate strategy for financing long-term care within a framework that enhances continued participation and function in the community to the greatest extent possible, and reinforces the informal care and supports that currently exist. When home care is no longer feasible because of mental confusion, incontinence, and extreme disability, and when the burdens on caretakers become too large, we seek a competent and caring institutional environment.

Considerable consensus exists on goals, but the enormous potential costs of long-term care give most policymakers reason to pause. More attention is now being given to the potential of long-term care insurance and community organizational structures that can bring together and coordinate a broader range of care needed by the frail elderly. 15 The current social health maintenance organization (SHMO) demonstrations supported by the Health Care Financing Administration (HCFA) should provide useful information on the viability of this approach.Advocate for Health Care Policy Assignment Paper

Intuitively, it seems plausible that if we appropriately organize home and community services for the elderly, we should be able to provide high-quality care at a cost comparable to or less than that of institutional care. But what seems intuitively plausible is not necessarily true, and we have much to learn about how better to target individuals truly at risk of institutionalization who can, with appropriate services, remain in the community 16 Moreover, when individuals are sufficiently debilitated and confused, and require sophisticated services and high levels of supervision, institutional care may be the less expensive alternative. Similarly, the burden on caretakers must be factored into consideration. In short, we need better concepts of triage that identify what patients and needs are most appropriately cared for in varying service contexts.

Cost per person must be differentiated from aggregate costs for populations. Most elderly hang on in the community as long as possible. But an attractive community/home care benefit brings new clients, who contribute to a higher aggregate cost. Such benefits often become complements rather than substitutes. These new clients who are attracted to community care benefits are in need but less disabled than those at high risk of institutionalization. Patients with such characteristics who enter nursing homes frequently return to their own homes after a relatively short stay 17 Thus, while community care may be preferable, it must be justified on the basis of community values and quality of care, and not as a cost-saving alternative.

Eligibility screening.

If long-term care needs are to be met by a broader set of options than now exists, and at tolerable cost, then screening for eligibility for services must be an important component of any program. Sophisticated evaluation is essential, but screening costs can be expensive because those at risk are a small proportion of the frail. The preservation of informal supports is extremely important, but can be undermined if programming strategy is not mindful of the extent to which community sustenance depends on this hidden system of care. Incentives can reinforce and strengthen these informal networks by helping reduce burdens on caretakers and providing respite opportunities.Advocate for Health Care Policy Assignment Paper