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The history, structure, and process of healthcare policy and politics in nursing and the healthcare delivery systems in the United States have evolved significantly over time. This discussion will provide a detailed overview of these aspects.
Historically, healthcare policy in the United States has undergone various transformations. The early years of American healthcare were characterized by limited government involvement, with private practitioners and charitable organizations primarily providing healthcare. However, in the mid-20th century, major policy changes occurred with the establishment of government-sponsored healthcare programs such as Medicare and Medicaid (Yearby et al., 2022). These programs aimed to provide healthcare coverage for specific populations, such as older adults and low-income individuals and significantly expanded the government’s role in healthcare.
The healthcare policy and politics structure in the United States is complex and involves multiple stakeholders. The government plays a central role in healthcare policy through federal agencies such as the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). Additionally, state governments have their own healthcare policies and programs, leading to a complex interplay between federal and state regulations (Yearby et al., 2022). Private healthcare organizations, insurance companies, professional associations, and advocacy groups influence healthcare policy through lobbying and advocacy efforts.
The process of healthcare policy development involves multiple stages. It typically begins with agenda-setting, where issues are identified and prioritized for policy consideration. Various factors, including public opinion, research findings, and political pressures, can influence such. Once an issue is on the policy agenda, policymakers engage in the formulation stage, where specific policy proposals are developed (Keirns, 2023). This stage often involves extensive research, analysis, and consultation with experts and stakeholders. The next stage is the implementation of the policy, which can involve the enactment of legislation, the establishment of regulations, or the adoption of administrative guidelines. Finally, policies are evaluated to assess their effectiveness and make any necessary adjustments.
In nursing, healthcare policy and politics play a crucial role in shaping care practice and delivery. Nursing organizations, such as the American Nurses Association (ANA), advocate for policies that promote the interests of nurses and ensure high-quality patient care. Nurses also engage in policy development and implementation by serving on advisory committees, participating in legislative advocacy, and providing expert input on healthcare issues (Schneller & Safriet, 2020). They play a vital role in bridging the gap between policy and practice, translating policy decisions into action at the bedside.
The healthcare delivery system in the United States is a complex mix of public and private entities. It is characterized by a fragmented structure, with multiple providers, insurance plans, and payment mechanisms. The dominant healthcare delivery model is a fee-for-service system, where healthcare providers are reimbursed based on the quantity of services provided (Schneller & Safriet, 2020). However, value-based care has been increasingly emphasized, which focuses on improving patient outcomes and controlling costs. This shift has led to implementation of alternative payment models, such as accountable care organizations (ACOs) and bundled payment arrangements.
In recent years, healthcare policy and politics have been marked by ongoing debates and efforts to improve access, affordability, and quality of care. Issues such as healthcare reform, insurance coverage expansion, prescription drug pricing, and the social determinants of health have been prominent in policy discussions. The Affordable Care Act (ACA), enacted in 2010, was a significant policy milestone that aimed to increase access to healthcare through insurance market reforms, the expansion of Medicaid, and the establishment of health insurance exchanges (Keirns, 2023). Altogether, the history, structure, and process of healthcare policy and politics in nursing and the healthcare delivery systems in the United States are dynamic and multifaceted. They have evolved, with significant government involvement and the engagement of various stakeholders. Understanding the complexities of healthcare policy and politics is crucial for nurses to advocate for their profession, contribute to policy development, and ultimately improve patient outcomes.
References
Keirns, C. (2023). History of Health Policy: Explaining Complexity through Time. Journal of the History of Medicine and Allied Sciences, 78(1), 34-45.
Schneller, H., & Safriet, B. J. (2020). The Changing United States Health Care System. Policy & Politics in Nursing and Health Care-E-Book, 121.
Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural Racism In Historical And Modern US Health Care Policy: The study examines structural racism in historical and modern US health care policy. Health Affairs, 41(2), 187-194.
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