Health Policy and Financial Considerations, Capstone Project Example

Healthcare policy provides a framework for addressing the challenges and considerations of finance and its influence on decision-making and patient outcomes. Field experts have established numerous policies and procedures that have a financial impact on care and treatment across specialty areas; therefore, it is important to identify these influences and how trends within the healthcare industry have translated into financial challenges and advantages for patients. The need for uniform policies and procedures that are applicable to a variety of areas is essential, yet it is difficult to accomplish this objective without shifting policies towards this objective (Tanenbaum, 2013). In critical care, for example, the cost of providing patient care for seriously ill patients continues to increase, thereby creating a greater burden on the entire healthcare system and a greater focus on disease prevention and management of chronic diseases (Coopersmith et.al, 2012). Trends regarding current policies are often disseminated in news outlets when they impact the general public in a significant manner, accompanied by policy inserts and websites, including those produced by state agencies, where healthcare policies continue to evolve and serve as a critical priority within a given state and on the federal level. These efforts must support a dynamic in which the practical side of healthcare dynamics must be considered in order to effectively promote a successful campaign to influence healthcare in a positive and meaningful way within the public sector. These efforts will likely benefit the end users in a manner that is beneficial to their needs, rather than to take away from the advantages that high quality healthcare has to offer.

Healthcare financing is largely based upon legislative processes, as demonstrated through funding for Medicare and Medicare Services and the Affordable Care Act. Furthermore, the delivery of services to patients in need is largely diverse and is often attributed to location (urban vs. rural), resource allocation, and spending patterns (Shi & Singh, 2014). As a result, it is important to identify areas whereby the delivery of care is affected by legislation, particularly when funding is reduced, creating a trickle-down effect to patients. It is necessary for legislative decision-making to be timely and practical, based upon the considerations of the end users, those who require healthcare services throughout the life span. Legislative bodies often hold up or prevent practical legislation from taking place that may positively impact patient care quality; therefore, greater attention must be paid to these issues in order to proactively improve resource allocation and cost effectiveness throughout the healthcare industry in a manner that does not compromise healthcare practice in any way. In addition, legislation and funding must not hamper activities and service delivery that will have a positive impact on patient care and treatment, even if the topic or organization may be controversial, particularly if the greater good of healthcare practice may benefit from these efforts. This process requires a delicate balance between providing sufficient resources to accommodate healthcare needs and supporting an environment in which ethical and practical decision-making go hand-in-hand with legislative processes.

Financial reimbursement within the healthcare industry is complex and  intricate; however, its most important asset should be its ability to drive high quality healthcare that has significant value to the consumer across all specialty areas (Manary, Staelin, Boulding, & Glickman, 2015). In order to achieve this far-reaching objective, it is necessary for organization s to evaluate their reimbursement policies in a manner that is consistent with high quality delivery of care and the ability to promote disease prevention in a cost effective and cohesive strategy. There must be a greater understanding of the drivers behind financial reimbursement and its influence on healthcare quality, as well as how quality affects reimbursement in different ways. When reimbursements are reduced, it is possible that there is less motivation to maintain high quality standards of care; however, there must be an even greater motivation to improve these standards and to promote consistency in quality of care to improve outcomes. Nonetheless, high quality care that is delivered on a continuous basis is often very expensive and cost prohibitive in an effort to provide additional services to patients; therefore, a collective balance must be achieved that supports both of these paradigms effectively. If financial reimbursement is cost effective and also supports value-added and high quality services for the consumer, the benefits of this negotiation outweigh the risks and support a positive and appropriate dynamic throughout the healthcare industry. This also reflects a need to modify reimbursement processes and policies as necessary to improve quality of care and to place a greater emphasis on patient needs above all other considerations.

Nurses and professional organizations play an important role in advancing the objectives of healthcare practice and policy in many ways. In recent years, healthcare organizations throughout the world have placed a greater emphasis on nursing practice as part of a larger framework to improve quality of care and service delivery (Van den Heede & Aiken, 2013). Nurses must continue to explore strategies to improve patient quality of care and support improvements in the practice setting that emphasize evidence-based solutions and translate these into feasible policies that govern their organizations. With this perspective in mind, healthcare organizations must be able to support nurse-led efforts to accommodate ever-changing patient care needs and influence the discussion regarding cost effective healthcare and preventive methods. These efforts will ensure that policies governing healthcare practices will be supportive of nurses and enable them to administer care and treatment in the desired manner without restrictions or other limitations. Therefore, new and existing policies must support the initiatives set forth by nurses to improve their ability to administer high quality care and treatment to their patients, and in turn, their efforts must drive policy making to new heights through evidence-based practice.

References

Coopersmith, C. M., Wunsch, H., Fink, M. P., Linde-Zwirble, W. T., Olsen, K. M., Sommers, M. S., … & Deutschman, C. S. (2012). A comparison of critical care research funding and the financial burden of critical illness in the United States*. Critical care medicine, 40(4), 1072-1079.

Manary, M., Staelin, R., Boulding, W., & Glickman, S. W. (2015). Payer mix & financial health drive hospital quality: Implications for value-based reimbursement policies. bsp, 77.

Shi, L., & Singh, D. A. (2014). Delivering health care in America. Jones & Bartlett Learning.

Tanenbaum, S. J. (2013). Reducing variation in health care: The rhetorical politics of a policy idea. Journal of health politics, policy and law, 38(1), 5-26.

Van den Heede, K., & Aiken, L. H. (2013). Nursing workforce a global priority area for health policy and health services research: a special issue. International Journal of Nursing Studies, 50(2), 141-142.