Chapter 23 Health Policy and Politics Get Involved

Chapter 23 Health Policy and Politics: Get Involved! Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Health Policy Nurses’ Involvement in Health Policy and Political Action Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nurses’ Involvement Has Become More Intense State and federal governments play an increasingly important role in health care, especially as federal and state governments and multiple private players embark on health care reform Nursing practice is directly affected by health policy development which is, in turn, affected by the political action of citizens—nurses and many, many others Patient safety and quality; access to affordable health coverage and services; and costs, value, and outcomes of services have become a major debate among policymakers National attention on nurses and nursing has intensified—our numbers, education, scope of practice, and overall value to the health care system Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3

Health Care Decisions Will Be Made with or without Nurses’ Input Patient care and nursing practice is a political endeavor Essential that nurses are involved to ensure that the nursing perspective is represented Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 4

Health Policy What Is Health Policy? Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Definition Set course of action taken by governments or health care organizations to obtain desired health outcome Private health policy is made by health care organizations such as hospitals and managed care organizations Public health policy refers to local, state, and federal legislation; regulation; and court rulings that govern the behavior of individuals and organizations in the provision of health care services Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 6

Health Policy at the Local, State, and Federal Levels Local health policy Cities or counties offer a variety of health care services to meet the needs of their residents Ø Examples include free or reduced-rate immunizations, tobacco-free public buildings, safe drinking water, enforcement of seat belt and child restraint laws, and provision of an emergency medical system Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7

Health Policy at the Local, State, and Federal Levels (cont'd) State health policy Governs nursing through nurse practice act Ø Provides “invisible services” through regulatory activities Ø • Maintaining a safe meat supply through livestock inspections • Ensuring safe food storage and preparation in restaurants • Ensuring that health care facilities provide safe, quality care Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 8

Health Policy at the Local, State, and Federal Levels (cont'd) State health policy Ø Pays for health care services through various programs: • Medicaid and State Children’s Health Insurance Program (SCHIP), which are partly funded by federal funds • Other indigent care programs, which vary from state to state Ø A key piece of the health care reform legislation is the opportunity for states to develop State Health Insurance Exchanges (SHIEs)—a set of state regulated and standardized health care plans from which individuals may purchase health insurance eligible for federal subsidies Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 9

Health Policy at the Local, State, and Federal Levels (cont'd) Federal health policy Funds health-related research Ø Funds education for health professionals, including nurses and physicians Ø Pays for health care through Medicare, Medicaid, SCHIP, and the Veterans Administration health care system Ø Plays a monumental role in shaping nursing practice Ø Passage of the Patient Protection and Affordable Care Act (PPACA) (2010) Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 10

Health Policy at the Local, State, and Federal Levels (cont'd) Federal policy that shaped nursing practice Nurse practice acts and registration of nurses (implemented in most states by 1910) Ø Sheppard-Towner Act (1921) Ø Hill-Burton Act (1950) Ø Medicare program (1965) Ø Renal disease program (1972) Ø Diagnosis-related groups (DRGs) (1983) Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11

Health Policy Development Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Definition Complex, dynamic process; occurs in various ways Enactment of legislation and accompanying rules and regulations that carry the weight of law Ø Administrative decisions made by various governmental agencies Ø Judicial decisions that interpret the law Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 13

Definition (cont'd) Involves numerous individuals and groups Elected officials Ø Officials from governmental agencies Ø Experts in the related area Ø Stakeholders such as corporate representatives Ø Representatives from special interest groups Ø Other affected citizens Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 14

Definition (cont'd) Involves all three branches of government Executive Ø Legislative Ø Judicial Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 15

Legislation and Health Policy Development Legislative process fundamental to movement from a public problem to a viable program Societal problems that may qualify for a policy solution are those brought to the attention of a policymaker who is willing to take definitive action through the policy process Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16

Legislation and Health Policy Development (cont'd) Analysis of issues for potential policy development Public perception of the problem Ø Definition of the problem Ø Societal consequences and number of people affected Ø Degree of support and opposition from stakeholders Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 17

Steps in the Legislative Process Include introduction, committee action, House and/or Senate action, and presidential action Very complex and convoluted process, with only a fraction of legislation that is introduced actually making it through the final process to become law Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18

Steps in the Legislative Process (cont'd) Once a bill becomes law, implementation falls under jurisdiction of one of the departments of the executive branch Implementation of new legislation often can be very different from what was intended when the bill was passed by Congress Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19

Health Policy Regulation and Health Policy Connection Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Regulation and Health Policy Connection Regulation: written set of rules issued by the government agency that has responsibility for administering the new law Nurses can play an influential role by providing input into the final regulations Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 21

Regulation and Health Policy Connection (cont'd) Interval between interim rules and final rules critical for assessing effect of the policy; concerted nursing action is required Regulations carry the force of law Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 22

Health Policy and Politics: Another Key Connection Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Definition of Politics Process by which the decisions of others are influenced and control over situations and events is exerted Influence is the common denominator in any definition of politics Forms of political influence include money, knowledge, relationships, information, talent, and control over large groups of votes Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 24

Politics and Policy Politics is a necessary part of the policy process when multiple interest groups compete to achieve individual goals Politics also involves the varied agendas of the Democratic, Republican, and Independent parties Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 25

Politics and Policy (cont'd) Groups and individuals who have a stake in the fate of a piece of legislation or the election of a candidate use political strategies to attain their desired outcomes Through effective political action, nurses can positively influence legislative decisions and health policies Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 26

Health Policy and the Nursing Process Nursing process is effective in identifying broader professional and health care issues Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 27

Health Policy and the Nursing Process (cont'd) Policy process and nursing process are systematic approaches to address health care and nursing laws Ø Collection of information (assessment)—information and data must be gathered from as many sources as possible before the health care issues can be identified Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 28

Health Policy and the Nursing Process (cont'd) Identification of issues (diagnosis): information analyzed to identify real issue or problem that needs to be addressed Development of a plan: includes options and a determination of professional consequences with each Implementation of the plan: requires political action and a set of strategies Evaluation of the intervention Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 29

Health Policy Grassroots Political Strategies Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Grassroots Political Strategies Registering to vote and voting in all elections Joining a professional nursing organization Working in candidates’ campaigns Attending a “meet the candidates” town hall meeting Visiting with policymakers or their staff Communicating with policymakers by e-mail, fax, and phone Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 31

1. A proposed city ordinance is pending with the local government that will require public buildings and restaurants to be smoke and tobacco free. Which action by the nurse should have the greatest effect on passage of the bill? A. Explain the rationale for the bill to your book club and gain their support. B. Contact the elected representative’s office by phone to request support for the bill. C. Support a health advocate to run for election as city councilman. D. Tell all fellow students about the bill. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 32

2. When participating in grassroots political strategies, the nurse should: A. Refuse to vote in all elections until access to health care is universal B. Withdraw membership to professional nursing organizations until the nurse/patient ratio is reduced nationally C. Educate candidates about the effects of the nursing shortage on the quality of patient care and patient safety D. Avoid raising issues of economic uncertainty in health care Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 33

Health Policy American Nurses Association (ANA) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Overview Professional nursing organization that represents the nation’s 3. 1 million RNs Composed of 51 constituent/state nurses’ associations that represent state and U. S. territory nursing associations and includes many organizational affiliates Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 35

ANA Organizational Affiliates American Nurses Credentialing Center American Nurses Foundation American Academy of Nursing Specialty organizations such as the American Association of Critical-Care Nurses Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 36

Examples of ANA’s Policy Issues Medicare and Medicaid reform Patients’ rights Whistle-blower protection Access to health care Comprehensive health care reform Environmental and occupational health for nurses Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 37

Nurses Strategic Action Team (N-STAT) Unifies nurses’ political voices across the country to enact measures to enhance health care for all Empowers nurses by encouraging them to take action and make sure their opinions are heard and understood by Congress and the public Provides structure and coordination for nurses across the country to be involved in grassroots lobbying Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 38

Health Policy Current Health Policy Issues Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Health Care Reform General term used to refer to policy initiatives to effect significant changes in how health care is delivered and paid for Historic health care reform legislation has become a reality with passage of The Patient Protection and Affordable Care Act of 2010 Ø Provides for affordable and accessible health care coverage for all Americans Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 40

Health Care Reform (cont'd) Access to care is the most significant problem to address through health care reform Lack of insurance: greatest barrier to access to health care Ø 50% of the uninsured have no regular source of health care Ø Uninsured more likely to delay or ignore needed treatment Ø Uninsured more likely to be hospitalized for avoidable conditions Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 41

The IOM Future of Nursing Report calling attention to the essentiality of nursing in reforming the health care system Four major recommendations: Nurses should practice to the full extent of their education and training Ø Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression Ø Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States Ø Effective workforce planning and policymaking require better data collection and information infrastructure Ø Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 42