Q discussion NUR678 Health Economy

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School

Purdue University *

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Course

N678

Subject

Health Science

Date

Dec 6, 2023

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docx

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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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