A historical analysis of the US healthcare system would reveal that it has undergone numerous changes over the years. Originally beginning as a charitable system in which those who were sick paid very little or no fees at all in order to receive treatment, the industry has evolved into a business oriented entity in which financial management, strategic planning, functional specialties as well as operational control take center stage (Schoenbaum et al., 2008). Healthcare has become one of the most important industries in the country, employing more than 13 million people with the numbers projected to increase even further in the coming years. Taken collectively, the healthcare industry consists of the organization of people, resources as well as institutions that provide healthcare services aimed at meeting the healthcare needs of a specific population (Yih, 2016).
From the above definition, it is quite clear that there are many components of the healthcare delivery system. One such component that has received widespread coverage over the past few years has been healthcare insurance. As part of the American healthcare delivery system, healthcare insurance has undergone a series of changes that have had a significant impact on various stakeholders, especially patients in acute care setting (Schoenbaum et al., 2008). The passing of the Affordable Care Act of 2010 is the most recent activity that has transformed the healthcare insurance landscape. The changes brought about by this law aimed at ensuring that an increased number of Americans have access to quality care. The Affordable Care Act has so far lived to its expectations, given the tremendous increase in the number of Americans who have a health insurance cover over the past few years (Lathrop & Hodnicki, 2014). For patients in acute care setting who are low or middle-income earners, having a health insurance cover translates to increased and less costly access to quality care (Lathrop & Hodnicki, 2014).
Structure of Healthcare Organizations and Nursing Practice
Both the health care delivery systems and healthcare organizations play a significant role in influencing patient outcomes, patient satisfaction as well as the quality of care. However, healthcare organizations are part of the whole system that makes up the healthcare delivery system (Crane, 2012). This means that healthcare delivery systems have an impact on a bigger population compared to healthcare delivery organizations which tend to serve specific groups of people with specific healthcare needs. The healthcare delivery system consists of a wide range of individuals and organizations including clinicians, healthcare facilities, clinicians, insurance providers as well as regulators. These individuals and organizations operate in different configurations of networks, groups and independent practices that collectively determine the quality of healthcare services delivered to the general public. On the other hand, healthcare organizations are responsible for the actual delivery of care to different groups of people that make up the population (Zaccagnini & White, 2014). Changes in the manner in which healthcare organizations serve the general public are brought about by changes in the different components of the healthcare delivery systems
The healthcare delivery system in the US is shifting from a fee-for-service system towards a managed care system. Through Medicaid, a lot of Americans are now served through the managed care delivery system (Paradise & Garfield, 2013). Effective functioning of the managed care system requires the active involvement of a number of organizations including insurance providers, hospitals and regulatory bodies. Taking Medicaid as an example of healthcare delivery system and American hospitals as an example of healthcare organizations, this section illustrates the differences and similarities that exist between the two regarding how they impact the quality and efficiency of healthcare in the country. Both Medicaid and hospitals need to be accessible to the general public for better quality and efficiency of healthcare to be attained (Paradise & Garfield, 2013). However, the nature of Medicaid has an impact on a bigger portion of the population since it uniformly applies across the country. This is unlike hospitals, where the quality of care delivered often varies from one entity to another. As such, it is difficult to generalize the impact the independent healthcare organizations have on the quality and efficiency of healthcare.
Healthcare Economics and Nursing Practice
Different groups of healthcare stakeholders continue to be affected by a host of healthcare economic issues the US. Patients are one of the stakeholders that have been adversely affected by the prevailing micro-economic and macroeconomic healthcare conditions. Some of the microeconomic healthcare conditions that have impacted patients include the increasing costs of healthcare, shift towards managed care as well as increased demand for high quality individual care (Thiess, 2012). On the other hand, the important macroeconomic healthcare conditions that have had a significant impact on patients include the increasing rates of unemployment, healthcare reforms as well as the slow rate of economic growth. The demand for healthcare services in the US has dramatically increased over the past few years. Factors that have contributed to this increase include the expanding baby-boomer population, increase the prevalence of chronic ailments such as cancer and cardiovascular disorders as well as the increasing shortage of medical practitioners including advanced nursing practitioners (Bodenheimer & Grumbach, 2012). The increased demand for healthcare services has also triggered an increased in cost of healthcare. Individual patients have to dig deeper into their pockets to access quality healthcare services (Thiess, 2012).
The shift towards managed care as a microeconomic health issue has also led many individual patients to enroll in both the public and private health insurance programs. The total number of Americans with insurance policies has significantly risen, especially in the period following the enactment of the Affordable Care Act. This change is closely related to healthcare reform, which is a macroeconomic healthcare condition. Healthcare reforms such as the Affordable Care Act have made it possible for low-income earners to access high quality care. However, the slow rate of economic growth accompanied by the increasing levels of unemployment means that a significant number of patients are still not enrolled in any health insurance program.
The Impact of Socioeconomic and Sociopolitical Factors on Healthcare Finance and Nursing Practice
Socioeconomic factors refer to the economic and social experiences that help shape the condition or situations individuals find themselves in. On the other hand, sociopolitical factors are those that related to both the political and social conditions in a given society. Both the socioeconomic and sociopolitical factors play an important role in shaping healthcare finance, especially among patients as one of the many stakeholders in healthcare (Bodenheimer & Grumbach, 2012). Patients with different socio-economic status have varying preferences and abilities as far as health financing is concerned. High-income earners often opt for private health insurance which offers more options compared to low-income earners who can only afford public-funded insurance programs such as Medicaid. Age is another socio-economic factor that affects the healthcare financing options that patients chose to use. The healthcare financing option among those aged below 18 years tend to be largely determined by the socio-economic status of their parents.
The sociopolitical factors that have an impact on the patients options when it comes to healthcare financing include power relations as well as structural issues. Under power relations, factors such as race and gender discrimination as well as redistribution of wealth go a great way in determining the ability of patients to finance for their healthcare. Those groups that have historically suffered discrimination and oppression often find it difficult to finance all their healthcare needs. As such, accessing quality healthcare has proved to be a significant challenge to minority groups such citizens of African and Hispanic descent. Structural issues include education as well as demographics. Highly educated individuals tend to be well aware of the need to have a proper healthcare plan compared to those who are less educated (Bodenheimer & Grumbach, 2012).
Bodenheimer, T. & Grumbach, K. (2012). Understanding health policy: A clinical approach (6th ed.). San Francisco, CA: McGraw-Hill Professional Publishing.
Crane, R. (2012). Healthcare Delivery Organizations. National Academies Press (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK52859/
Lathrop, B., Hodnicki, D., (2014) "The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse" OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 2.
Paradise, J. & Garfield, R. (2013). What is Medicaids Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence. Kff.org. Retrieved 30 August 2016, from http://kff.org/medicaid/issue-brief/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence/
Schoenbaum, S., McCarthy, D., Shih, A., Nuzum, R., Davis, K., & Gauthier, A. (2008). Organizing the U.S. Health Care Delivery System for High Performance. Commonwealthfund.org. Retrieved 30 August 2016, from http://www.commonwealthfund.org/publications/fund-reports/2008/aug/organizing-the-u-s--health-care-delivery-system-for-high-performance
Thiess, R. (2012). Rising health care costs are an economic, not a budget, problem. Epi.org. Retrieved 30 August 2016, from http://www.epi.org/publication/rising-health-care-costs-economic-budget/
Yih, Y. (2012). Handbook of healthcare delivery systems. Boca Raton, FL: CRC Press.
Zaccagnini, M. E., & White, K. W. (2014). The Doctor of Nursing Practice essentials: A new model for advanced practice nursing (2nd ed.). Sudbury, MA: Jones & Bartlett Publishers.
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