Q discussion NUR678 Health Economy
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Purdue University *
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Course
N678
Subject
Health Science
Date
Dec 6, 2023
Type
docx
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6
Uploaded by chang541
I thoroughly appreciate your insightful perspective on healthcare reform and the
complexities it presents within the governmental structure. Your focus on addressing social
determinants of health is truly commendable. Indeed, initiatives like the Accountable Health
Communities model can significantly impact healthcare outcomes and contribute to economic
efficiency (Gottlieb et al., 2017). Your points about the challenges in healthcare reform are well
noteworthy. Navigating the intricacy of the American healthcare system requires a delicate
balance between individual responsibility, family support, and societal obligation. I share your
concerns about the hurdles in larger healthcare reforms, such as transitioning to a single-payer
system. The intersection of political, financial, and social factors makes these reforms daunting.
Thank you for sharing your thoughtful insights. I believe that our collective dedication to
understanding these complexities will pave the way for a more equitable and efficient healthcare
system.
References
Gottlieb, L., Colvin, J. D., Fleegler, E., Hessler, D., Garg, A. & Adler, N. (2017). Evaluating the
accountable health communities demonstration project.
Journal of General Internal
Medicine, 32
(3), 345-349. Doi: 10.1007/s11606-016-3920-y.
As for the health economics concepts you've highlighted, your awareness of the practical
implications in your role as a nurse practitioner and healthcare leader is truly noteworthy. Your
commitment to accessible and affordable healthcare resonates well with the evolving needs of
our society.
Thank you for sharing your thoughtful insights. I believe our collective dedication to
understanding these complexities will pave the way for a more equitable and efficient healthcare
system.
Your emphasis on initiatives targeting social determinants of health aligns with the
direction healthcare should take—toward holistic, community-based approaches.
To me, healthcare reform is horribly complicated with the structure of the American
government. The layers needed for change, political ideologies, and financial backing of interest
groups adds to the convoluted process.
However, a few options for healthcare reform can be
considered.
First, addressing social determinants of health both inside and outside healthcare policy
can have tremendous effects on healthcare and outcomes for Americans.
For example, public
transportation and nutrition programs as well as community-based initiatives can influence
health outcomes (Artiga & Hinton, 2019). Within the healthcare system, the Accountable Health
Communities model that connected Medicare and Medicaid beneficiaries with community
services (Artiga & Hinton, 2019) is a perfect example of ways to address social determinants of
health.
Further expansion of these initiatives at the state level would likely be morally
acceptable, economically effective, and politically feasible.
Last semester, I had the pleasure of listening to then State Health Commissioner, Dr.
Kristina Box (2023) discuss Indiana’s health measures and priorities for change.
Many of these
recommendations sought to address maternal and infant mortality, mental health issues, and
opioid and drug addiction (Box, K., 2023). To me, addressing these issues is very morally
acceptable without public dissent.
It is also economically efficient given staggering statistics
about the cost associated with untreated mental illness; that is, as much as $47.6 billion annually
is lost in productivity (Witters & Agrawal, 2022).
Compared without other options for health
reform, I believe initiatives that focus on social determinants of health are most likely to be
politically feasible.
I worry that larger reform, such as complete conversion to a single-payer
system would be met with so many challenges in the form of litigation, that it would never come
to fruition.
In addition, as we come to the end of the course, please identify three key health
economics concepts that you have learned that will impact your professional role in the care you
deliver and the organizations you will lead.
First, providers can play a role in reducing healthcare costs.
Hospital care is a
huge portion of healthcare spending (Henderson, 2023).
As an inpatient nurse practitioner, acute
care spending is incredibly applicable to my role.
I can help limit spending by avoiding
duplicate testing, taking the time to look through records, offer same-day appointments to avoid
ER visits and unnecessary visits, and focus on educating patients on healthy behaviors to avoid
the burden and cost of chronic disease.
Next, access to care is an important piece of the puzzle.
We have learned that
coverage for medical care does not always mean beneficiaries are able to receive care
(Henderson, 2023).
Advanced practice providers (APPs) like nurse practitioners can help with
access to care.
A 2017 RAND study demonstrated that if nurse practitioner practice limits in
Indiana were lifted, access to care would be improved for over 320,000 Hoosiers (Martsolf &
Kandrack, 2017). However, the American Medical Association (2023) in their advocacy against
APP expansion, argues that APPs increase cost of care by ordering more tests. In my
administrative role, we discuss access to care for surgical patients regularly.
I often argue that
access to care and APP utilization in this is different in surgical patients where an APP cannot
provide definitive care. However, I think some sort of access in non-surgical subsets is possible.
For example, having an APP see peri-anal disease patients to provide lifestyle education prior to
surgical interventions for hemorrhoids or anal fissures.
Also, APPs can see post-op patients,
allowing new patients with cancer to have faster access to surgeon care.
Finally, affordability is something I will consider for all my patients.
This class
has demonstrated the impact of healthcare costs on Americans.
I have learned the cost of
common discharge medications over the years and strive to be mindful of this with every
discharge.
Often this creates more work for me in price checking prescriptions but is hopefully
helpful in patient compliance.
References.
American Medical Association. (2023, August 14). Advocacy in action: Fighting scope
creep. AMA.
https://www.ama-assn.org/practice-management/scope-practice/advocacy-
action-fighting-
scope-creep
Artiga, S. & Hinton, E. (2019, July 9). Beyond health care: the role of social determinants
in promoting
health and health equity. KFF. https://www.kff.org/racial-equity-and-health-
policy/issue-
brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-
and-health-
equity/
Box, K. (2023, January 26). IRHA public policy forum [PowerPoint slides]. Indiana
Department of Health.
Henderson, James. W. Health Economics and Policy, 8th Ed., Thomson/South-Western,
2023.
Martsolf, G. & Kandrack, R. (2017) The impact of establishing a full scope of practice
for advanced
practice registered nurses in Indiana. RAND Corporation.
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https://www.rand.org/content/dam/rand/pubs/research_reports/RR1800/RR1864/RAND_RR18
64.pdf
Witters, D. & Agrawal, S. (2022, November 3). The economic cost of poor employee
mental health.
Gallup. https://www.gallup.com/workplace/404174/economic-cost-poor-
employee-mental-
health.aspx
Thank you for sharing your insights on healthcare reform and the impact of health
economics concepts on your professional role. I appreciate your thoughtful analysis of the
complexities involved in healthcare reform, particularly in the context of the American
government's structure and the challenges posed by various factors like political ideologies and
financial interests.
Your focus on addressing social determinants of health as a viable option for reform is
well-founded. Initiatives that target social determinants, such as the Accountable Health
Communities model, have the potential to make a significant difference in healthcare outcomes.
Your emphasis on addressing issues related to maternal and infant mortality, mental health, and
drug addiction aligns with critical areas that demand attention and action.
Regarding the health economics concepts you highlighted, your approach as an inpatient
nurse practitioner to reduce healthcare costs through efficient practices and patient education is
commendable. The emphasis on access to care, especially through advanced practice providers
like nurse practitioners, is crucial for improving healthcare accessibility. Your focus on
affordability and the effort you put into ensuring patients can afford their medications
demonstrates your commitment to providing holistic and patient-centered care.
It's clear that you are deeply committed to making a positive impact on healthcare
delivery and are actively engaged in finding practical solutions to complex issues. Your
dedication to improving patient outcomes and advocating for accessible, affordable, and high-
quality care is inspiring. Keep up the excellent work!
I completely understand your concerns about the feasibility of transitioning to a universal
healthcare system in the United States. It's true that any healthcare system in the corresponding
country is deeply rooted in its unique political, social, and economic context. The success in
France might not directly translate to the nation due to the significant differences in
demographics and social disparities.
You raised a valid point about the challenges of transitioning, both logistically and
financially. It's a complex process that requires careful planning and consideration. Addressing
social disparities in health is indeed fundamental, regardless of the type of healthcare system in
place. Focusing on improving access to healthcare, reducing inequalities, and ensuring quality
care for everyone should be at the core of effort in any healthcare reform.
Addressing the structural flaws in the U.S. healthcare system necessitates a
comprehensive strategy that is morally sound, economically viable, and politically realistic. One
viable solution involves transitioning toward a universal healthcare system akin to models in
countries such as France. Integrating elements from both insured and supply models, a unified
public payer system could provide equitable healthcare rights to all citizens, addressing issues of
high costs and uninsured individuals (Galvani et al., 2020). This approach, exemplified in
France, promotes financial sustainability, ensuring affordable healthcare, while allowing
individuals to augment their coverage with private insurance for added benefits and provider
choices (Cancarevic et al., 2021). Furthermore, implementing healthcare policies emphasizing
preventive care and population health management can reduce overall costs by encouraging
healthier lifestyles and preventing chronic diseases. Reforms that prioritize accountable care
organizations and value-based care models, rewarding healthcare providers for delivering high-
quality, cost-effective care, can notably enhance healthcare quality and curtail unnecessary
expenses (Galvani et al., 2020).
Regarding key health economics concepts, understanding cost-shifting dynamics, where
healthcare providers offset the costs of free or undercompensated care to uninsured patients by
charging higher prices to insured patients, is pivotal for healthcare professionals. This awareness
profoundly influences decision-making in managing healthcare budgets and pricing structures
across all organizations (Henderson, 2023). Additionally, grasping the intricacies of healthcare
market competition and its impact on service quality and accessibility can guide organizations in
improving their services while effectively managing costs. Lastly, comprehending the
implications of healthcare policy changes, particularly concerning reimbursement mechanisms
and insurance coverage, is indispensable for making informed decisions in healthcare
management roles. This knowledge ensures the delivery of high-quality care while navigating the
complexities of the evolving healthcare landscape.
References
Cancarevic, I., Plichtová, L., & Malik, B.H. (2021). Healthcare Systems Around the World. In:
Tohid, H., & Maibach, H. (eds
) International Medical Graduates in the United States
(pp. 45-79). Springer, Cham. https://doi.org/10.1007/978-3-030-62249-7_3
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, 395
(10223), 524-533. Doi:
10.1016/S0140-6736(19)33019-3.
Henderson, James W. (2023).
Health Economics and Policy
. Cengage Learning.
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