Does the term healthcare policy sound familiar? Well, if you are asking, ‘What is healthcare policy?’ We will give you a brief definition of the term. Healthcare policy refers to the actions, decisions, and goals determining how care is accessed and delivered to the nation’s healthcare system. For instance, healthcare policies can involve legal and safety regulations by the government regarding how healthcare providers diagnose, treat, and care for cancer patients at a specific hospital.

Healthcare policy can be structured at a national or state level and more finely adjusted in a clinical or hospital environment. The policy applies to the pharmaceuticals, insurance, and health information technology sectors.

Its purpose is to give healthcare providers a sense of direction regarding service provision to achieve either short-term, medium-term, or long-term goals. The health care policy also institutes roles and expectations for nurses, doctors, and other service providers in the clinical/hospital setting.

Healthcare Policy Issues 

Some of the top 10 healthcare policy issues include:

  1. Mental health issues

Some issues, such as employment, suicide rates, substance abuse, physical health issues, family conflicts, and legal issues, affect healthcare providers globally. Mental problems arise from these factors and largely affect hospital service provision. A healthcare provider Protection Act protects healthcare providers from such issues.

  1. COVID-19 Pandemic

COVID-19 contributed the most to healthcare policy changes in 2021. This pandemic has been driving policy decisions at national, state, and hospital levels, from testing, isolation, and access to vaccination. 

  1. Telehealth waivers

During the COVID-19 pandemic, the state allowed flexibility to healthcare providers to deliver services to Medicare beneficiaries via telehealth. It is one of the arising issues in healthcare policy because we are still determining whether the legislators will extend the waiver. 

  1. Health Equity

One of the main healthcare policy issues in the United States is health equity. The current administration has focused on health equity: One of the current president’s first actions in office was the signing of a health equity executive order. More health equity initiatives could be beneficial to low-income earners in 2022.

  1. Build Back Better

The bill’s key provisions, which face an uphill battle in Congress, include a proposed extension of the Affordable Care Act and prescription drug pricing reforms.

  1. Drug pricing

Along with reforms proposed in the Build Back Better bill, this year, the 340B program, which allows limited access to lower-cost prescription drugs, will be considered by the courts. 

  1. Surprise billing

Healthcare providers and payers are scrambling to implement the No Surprises Act. Some lawmakers are primed to press their colleagues in Congress for changes.

  1. Physician payment

The prospect of a cut in Medicare payments to physicians set for 2022 prompted Congress to pass the Protecting Medicare and American Farmers from Sequester Cuts Act at the end of 2021. However, Congress’s action is considered a stopgap rather than a permanent solution

  1. User fee reauthorization legislation

Every five years, the FDA must negotiate user fee agreements with industries it regulates. These fees account for about 80 percent of the agency’s personnel costs. These agreements have already been finalized and sent to Congress, but lawmakers could add CMS policy. 

  1. Value-based care

This is a reimbursement model that rewards doctors, hospitals, physicians, and other healthcare providers with payment incentives based on the quality of care they provide to patients. It is a rising issue that aims at reducing the cost of health care, providing better care for individuals, and improving the population’s health management strategies.

Risk Management and Healthcare Policy 

Risk management plays a vital role in healthcare. Risk managers should take seriously the complexity associated with healthcare service provision. Healthcare policy and legislation go handy in handy. While licensing standards, regulations, and third-party payer requirements contribute to this complexity, risk management, and healthcare policy, formalized policies, and procedures in healthcare can mitigate it. That could be by promoting regulatory compliance, workplace safety, and the delivery of high-quality and safe patient care. Moreover, well-written, up-to-date policies and procedures in healthcare reduce practice variability that may result in patient harm and substandard care.

The Purpose of Policies and Procedures

Written policy and procedures fulfill several important purposes:

  • They help to promote adherence to recognized healthcare professional practices.
  • Policy and procedures help to promote compliance with regulations, statutes, and licensing requirements. For example, HIPAA
  • They help to minimize the cases of practice variation.
  • They bring standardization of practices across multiple entities within a single healthcare system.
  • They serve as a resource for new personnel in the hospital or clinic
  • Help to eliminate high reliance on memory which results in a high rate of human errors

What is Healthcare Policy in Nursing

Nurses know the specific needs of the people they serve because they spend a lot of time working directly with them. If you are asking,’ What is healthcare policy in nursing?’ We can define it as decisions, goals, and actions set to help nurses serve as advocates for patients, families, communities, other nurses, and healthcare organizations.  

Through their advocacy, nurses can influence healthcare policy. By gaining a comprehensive understanding of and specialization in particular areas of health care, nurse practitioners are uniquely situated to support positions that will benefit our communities.

Nurses and Healthcare Policy

The relationship between nurses and healthcare policy begins when nurses engage in their jobs and roles in a healthcare setting. The responsibilities of a nurse in healthcare policy include the following:

  • They prepare healthcare policy briefs
  • The nurses develop, propose, and implement new healthcare policies
  • They advise policymakers, leaders, and the public
  • Advocate for patient needs
  • Research public healthcare policy issues
  • Analyze and evaluate healthcare policy and legislation
  • Administer grants

Healthcare policy in the United States

In the United States, there is a third-party payer system of healthcare. That means the third-party health insurance plan reimburses doctors for the bulk of the cost of healthcare services provided to patients. There is a mixed system of public and private insurance. 

The two major public programs are Medicaid, for individuals with disabilities and low-income earners, and Medicare, for people with kidney disease, 65 years or older or younger people with certain disabilities. Most American citizens are enrolled in private health insurance through their employers. Most insured people purchase private insurance through the individual market or receive insurance through a different publicly funded program.

Ways Public Policy Can Influence Health

The following healthcare public policy areas can greatly impact the healthcare system.

  1. Public policies can create, regulate, and maintain public goods that foster supportive environments for good health.
  2. An example is sewage and drainage systems in the state. How these facilities are planned, constructed, connected, and maintained can affect the citizen’s comfortability and health.
  3. Public policies can provide direct support in ways that affect the drivers of health.
  4. Some programs provide temporary cash assistance to help pay for basic needs like food, housing, and transportation while providing requirements, opportunities, and incentives for work training and employment.
  5. Public policies can set requirements and mandates that protect citizens.
  6. Laws against alcohol-impaired driving are examples of public policies designed to protect citizens against accidents.
  7. Public healthcare policies can reduce barriers, create opportunities, or provide incentives that influence health choices.

 One example of how public policy can create an opportunity to improve a driver of health is       Tennessee’s HOPE scholarship. The HOPE scholarships are designed to reduce financial barriers and create the opportunity for some Tennessee students to attend college and attain a higher level of education. 

Healthcare Program/Policy Evaluation Analysis Template

Depending on the program or policy evaluation you are working on, address the following as you complete the healthcare program/policy evaluation analysis template.

  • Describe the outcomes of the healthcare program or policy.
  • How successful was the program or policy measured?
  • State how many people were reached by the program or policy selected
  • How impactful was the program or policy selected?
  • At what point in program implementation was the program or policy evaluation conducted?
  • What type of data was used to conduct the program or policy evaluation?
  • Was any specific information identified on unintended consequences?
  • Who were the stakeholders identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
  • Did the program or policy meet the primary goals and objectives? Why or why not?
  • Would you recommend implementing this program or policy in your place of work? Why or why not?
  • Identify at least two ways you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.

The Rising Cost of Healthcare

Healthcare policy affects not only the cost incurred by citizens to pay for medical care but also their access to care and the quality of care received. That can influence their general health conditions. It is becoming difficult for low-income earners to afford medical care services due to the rising cost of living. 

All the policies made by the government or healthcare system leaders affect people’s health, either positively or negatively. Hence, it is important to involve the care providers in healthcare policymaking to ensure that it is inclusive, and that the needs of every stakeholder are met.