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Monday, April 4, 2011

Health Care Reform: what is in it for patients and nurses?

 You might know from my previous posts that nursing, not politics, is my life. Despite that, the issue of the health care reform raises a lot of questions and concerns.
As a product of a health care reform, the Patient Protection and Affordable care act was signed into law by president Obama in 2010. Affordable health act is considered the most expansive social legislation enacted in decades: health-care provisions are designed to take effect over the next four years. By 2014, all the individuals will be required to have health insurance. Health care reform is intended to keep some things the way they are, as well as introduce changes to the cost and availability of the health insurance coverage. Employers will continue to provide health insurance to the majority of the population through private insurance companies. If the employer offers coverage but the employee’s share of the premium exceeds 9.5 percent of his/her income, the employee should be able to get subsidized coverage. This will affect employees, whose income is less than $43,320 per person (or 400 per cent of poverty level income).*see footnote The law also caps how much people have to spend on out-of-pocket expenses. These changes raise heated debates about the health care reform. On one side of the spectrum, the impoverished sector indeed will be provided free or heavily subsidized medical care. The poorest will get medical help, as well as the very young ones who chose not to have insurance relying on a chance they don’t need medical services. On the other side of the spectrum, there are millions of Americans, who will not qualify a subsidy, who will have to pay high premiums and out-of-pocket expenses, especially if they have a chronic illness. In my opinion, the difficulty foreseeing the results of the health reform rise from the complexity of the issue as well as the diversity of the population of the country.
Health care reform introduces changes to the Medicare social insurance program as well. For example, payments for most Medicare providers across health care settings will be influenced by patient outcomes and include an emphasis on integrated care coordination. There are advantages and disadvantages in this change. The health care system will shift gears to preventative medicine, educating patients on healthy lifestyles, health maintenance and disease recurrence prevention. The plan sounds reasonable for the patients – they will receive the best of care, but it may back-fire on the health care facilities. First, positive patient outcomes are not always achievable in the presence of chronic illness, which means a hospital or a clinic may not get reimbursed for incompliant “frequent flyers”. Second, the establishment of Patient-Centered Outcomes Research institute raises ethical and financial concerns. If the institute deems a certain medical intervention as clinically inappropriate or ineffective, the health facility would ultimately not get paid for it. Can a doctor still promise “to do everything that we can” to save a patient’s life, or will his decision be influenced by the possibility of not ordering a test because it is not paid for?
While I think that a health care reform is a difficult and much-needed change to the insurance-controlled health care system in the country, there should be multiple approaches to what is changed, who is affected by the changes, and how the changes are introduced. Yes, U.S. has to ration just like the rest of the world, when it comes to health care, but the nation that is built on fairness to all, should ration fairly, with the emphasis on what is effective and cost-effective, not solely on the persons’ ability to pay.
Health care reform affects nursing in many direct and indirect ways. For example, the nurses will have to place higher emphasis on patient teaching and disease prevention. Nursing care may be shifted to the community sector as the government attempts to decrease the number of hospitalizations. Clinics, visiting nurses agencies and rehabilitation facilities may become primary centers of patient care. Nursing will have to expand practice and create new roles. Nursing practice will need to be evidence-based more so than now to fulfill government reimbursement requirements, so higher emphasis will be placed on nursing education. At this day of age, the healthcare system doesn't provide sufficient incentives for nurses to pursue higher degrees and additional training.  Lack of financial incentive and increased work burden may bring about shortage in nursing.

*hmmm, so if an average RN falls in the category of making more than $43,320, my health insurance may be costing me  $43,320 x 0,095 = $4,115? wow, that is a lot more than I know young RNs are paying now for the coverage.... What about my 50-year-old co-workers, can they really afford to pay more and still retire?

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