ACA ends the ability of insurance companies to
deny covergae to peple with pre-existing conditions, to deop people once they aqcuire a costly illness, or to apply annual and lifetime caps on coverage

health promotion and wellness, disease prevention, chronic care management
-ACA replete with opportunities to test models of care that already hold promise for improving health outcomes and lowering health care costs. Center for M/M innovations and other pilot programs and demonstration projects will test and develop ideas ranging from transitional care to nurse managed centers, both which have been innovations led by and using nurses
-Medical or health homes
-community based health centers will be expanded in areas where there are health care provider shortages (RNs) and APRNs will staff these) – emphasis on primary care will increase demand for NPs
-payment reforms include piloting bundled payments and care coordination through “accountable care organizations”
-independence at home models to keep older adults healthy and functioning in own homes

Medical homes are
single provider or health teams that take responsibility for coordinating all of the care for patient it serves, whether this entails educating and coaching pts to better manage chronic ellness or ensuring that specialty care is provided and consistent with patients’ needs or providing transitional care from hospital to home
Nurses and social workers are the people who are and will be doing most of this care coordination

Accountable care organizations (ACOs) are
similar to integrated delivery systems that combine services across health care settings and are able to focus on ways to improve care delivery and health outcomes under bundled payment scheme
Bundled payments will provide financial inventive to providers and health systems to keep pts healthy, rather than doing unnecessary tests and procedures that are currently covered on a fee for fserveice basis

Nurse family partnership is
home visitation programs for high risk mothers and infants
the law does not specify that the services be provided by nurses despite evidence that nurses produce significantly better outcomes than non nurses as home visitors

The deliberate course of action chosen by an individual or group to deal with a problem

Choices made by public government officials to deal with public problems
public policies

Public policies are authoritative decisions made in the legislative, executive, or judicial brances of government intended to influence the actions, behaviors, or decisions of others

When the intent of a public policy is to influence health or health care it is a
health policy

Social policies identify courses of action to deal with social problems

In a capitalist economy such as the US, private markets are permitted to control the production and consumption of goods and services, includinghealth services.
The govnt intrudes with policies only when the private markets fail to achieve desired public objectives.
When it is necessary for govnmt to intercede, two types of policy are used:
allocative policies
regulatory policies

____________ provide benefits to a distinct group of individuals or organizations at the expense of other to achieve public objective. (moving to those that are more disadvantaged “redistribution of wealth”) Shifting monetary resources. Expansion of medicaid was Allocative. Ex:
allocative policies

___________ are used to Influence, actions, behavior and decisions of individuals or groups to ensure public objective is met. Ex: 1% penalty (penalized for bad care). Ex; nurse practitioners cannot sign orders, referrals….
regulatory policy

subsidies are which type of policy

Is the ACA a regulatory or allocative policy?

Who makes policy?
Legislative: propose
Executive: of executive order: guns
Regulatory agency: CMS

Public policies reflect a society’s values and also conflicts between values.
Politics is the process of influencing the allocation of scarce resources
Allocation: decisions being made about how to distrivute resources
Influencing: opportunitites to shape the outcome of a process

Problems addressed by nurses (4)
health system: addressing patient outcomes
Social determinants
Improve health
FIgure 1-3 Mason

The framework for action use “spheres of influence” to conceptualize the places where nurses use politics to shape policy and to work for change in the health system
The original framework for action’s four spheres of influence were:
the workplace
the government
organizations: associations and interest groups

Workplace includes workforces and workplace

Nursing spheres of influences (4)
workplace and workfoce
the community
associations and interest groups
the government

Figure 1-3 The targets of the spheres of influence. Nurses work in 4 spheres of influence to shape health and social policy.
Policies are designed to remedy problems in the health system and to address social determinants of health to improve health
the workplace and workforce, the government, associations and interest groups, the community –> health and social policy –>health system and social determinants of health –> health

Sphere 1: community
While a limited # of nurses will have the opportunity to influence policy at the highest levels of govnmt, there are more extensive opportunities for nurses to influence health and social policy in communities
Community: a group of people who share something in common and interact with one another, who may exhibit a commitment with one another, and may share goegraphic boundary
May be a neighborhood, a city, an online gorup with common interest, or faith based network

Nurses can be influential in communities by
identifiying problems, strategizingwith others, mobilizing support, and advocating for change

Sphere 2: workforce and workplace

Outside of the workplace, policy is made that influences the size and composition of the nursing workforce
ACA authorizes increased funding for scholarships and loans for nursing education, potentiallly augmenting existing workforce programs funded under title 7 and 8

nurses work in a variety of settings: hospitals, clinics, schools, private sector firms, government agencies, military services, research centers, nursing homes , home health agencies
All of these environments are political ones: resources finite, and nurses must work in each to influence the allocation of organizational resources
Policies guide many activities in the health care workplaces where nurses are employed
Many that affect nursing a pt care are INTERNAL organizational policies such as staffing policies, clinical procedures, and pt care guidelines.
EXTERNAL: operative in health care workplace also: for ex: state laws regulating nursing licensure and immunization requirements of clinical practitioners

Sphere 3 the government
government action and policy affects lives from birth until death
Funds prenatal care, inspects food, bans unsafe toy s and cares, operates schools, builds highways and regulates what is transmitted on airwaves.
Provides for common defense: supplies fire and police protection; gives financial assistance to the poor, aged, and others who cannot maintain a minimal standard of living
Though most health care in the US is provided in the PRIVATE sector, much is paid for and regulated by the government.
Government plays a significant role in influencing nursing and nursing practice.
States determine the scope of professional activities considered to be nursing, with notable exceptions of the military, veterans’ administration and indian health services

Sphere 3 the government contd
federal and state governments determine who is eligible for acre under specific benefit programs and who can be reimbursed for providing care
Sometimes government provides leadership in defining problems for both the public and private sectors to address
There are many ways nurses can influence policymaking in the government sphere (at ALL levels of government [local, state, and federal]).
*** examples include: obtaining appointment or assignment to influential government positions; serving in federal, state, and local agencies; serving as elected officials; working as paid lobbyists; communicating to policymakers their support or opposition to a policy; providing testimony at government hearings or open meetings; participating in grassroots efforts, such as rallies to draw attention to problems

political skill has 4 components
social astuteness
interpersonal influence
networking ability
apparent sincerity

Skill at being attuned to others and social situations; ability to interpret one’s own behaviors and the behavior of others
social astuteness

convincing personal style that influences others featuring the ability to adapt behavior to situations and be pleasant and productive to work with
interpersonal influence

The ability to develop and use diverse networks of people and the ability to position oneself to create and take advantages of opportunities
networking ability

the display of high levels of integrity, authenticity, sincerity, and genuineness
apparent sincerity

Sphere of influence 4: associations and interest groups
professional nursing associations have played significant role in influencing practice of nursing
Many professionla nursing associations have legislative or policy committees that advocate for ppolicies that suppor their member’s practice
ex: american nephrology nurses association
Working with a group increases the chances for advocacy to bbe effective, provides an environment where resources can be shared, and enhances networking and learning
*nurses can be effective in association policy activities by serving on public policy or legislative work groups, providing testimony, and preparing position statements
ANA, american public health association, sierra club

framework for action ow includes health as an element of the model to represent that optimal health is viewed as the goal of nursing’s policy efforts

Optimal health(either the individual patient’s or population’s) is the central
focus of the political policy activity described in this book
This focus makes it clear that the ultimate goal for advancing nursing’s interests must be to promote the public’s health

Health and social policy
health and social policy now appear as elements in the framework for action
Many factors that affect health status are social factors such as income, education, and housing
Thus it was important to idenfity the important role that social policies play in influencing health

Social determinants of health
An important update to the framework is the inclusion of the concept of social determinants of health
Even in the most affluent nations, people who are poor have substantially shorter life expectancies and experience more illness than the rich

While health can be improved with changes to the health system, an agenda for health imporvements should be based on understandding THE SOCIAL DETERMINANTS
Policies are needed to address the social and economic conditions that make people ill
Universal access to care is one social determinant of health

Forces that shape health policy
Interest groups: health science center
Media: debates, etc, influence
Science and researrch: many times undercut
Presidential power
Policy analysis and analyts
advocacy and activism

values influence all political and policymaking activities
Public policies reflect a society’s values and also conflicts between values

to support or oppose a policy requires value judgments
Conflicts between values were apparent throughout the debate on health care reform;

frequently associated with a negative connotation, yet it is actually a neutral term
Politics is the process of influencing the allocation of scare resources
Policymaking involves the distribution of resources; so politics or political action can be viewed as the efforts and strategies used to shape a policy choice

Politics is the process of
influencing the allocation of scare resources

Definition of policy contains several important concepts
Influencing: opportunities to shape the outcome of a process
Allocation: decisions being made about how to distribute resources
Scare: limits to amount of resources available- all parties cannot have all they want
Resources: usually considered to be financial, but could also include human resources (personnel), time, or physical space such as offices

political skill has 4 components
social astuteness
interpersonal influence
networking ability
apparent sincerity

Policy analysis and policy analysts
analysis is the process of examining an object and breaking it down to understand it better.
Policy analysis uses different methods to assess a problem and determine ways to resolve it
This encourages deliberate critical thinking about the causes of problems, identifies the various ways a government or other group could act, evaluates the alternatives, and determines the policy choice that is most desirable

Policy analysts are individuals who, with professional training and experience, analyze problems and weight potential solutions
citizens can also use policy analysis to better understand a problem, alternative, and potential implications of policy choices

Advocacy and activism
advocacy for one pt at at time has long been considered a core nursing role
Advocating for change through policy and politics permits nurses to advocate on a larger scale and is endorsed in nursing’s social policy statement, a document that defines nursing and its social context
Political activism may be associated with protests and ‘sit-ins’ but has grown to include diverse and effective strategies such as blogging, using evidence to support policy choices, and garnering media attention in sophisticated ways

Interest groups and lobbysits
interest groups advocate for policies that are advantageous to their memberrships
Groups often employ lobbysists to advocate on their behalf, and their power cannot be underestimated
in the US in 20009, about 1750 businesses and organizations spent at least$1.2 billion on lobbysits to advoacate for their interestes in the health care reform debate and on many other issues

traditional newpapaers to help disseminate storiess, interactive websites that profiled individual nurses and provided comparative data on disciplinary actions by other state boards for nursing
Media, social media –> further push their work out to other audiences

Science and research
scientific findings can play a pwerful role in the first step of the policy process – getting attention for particular problems and moving them to the policy agenda.
Research can also be valuable in defining the size and scope of a problem
This can help to obtain support for a particular policy option and in lobbying for support for it. evidence should be used to inform policy debates and shape policy choices the help ensure the solution will be effective

Presidential power
president embodies the power of the executive branch of government and is the only person elected to represent the entire nation
As the most visible government official, the president is able to propel issues to the top of the nation’s policy agenda
Though the president cannot introduce legislation, he can provide draft legislation and legislative guidance

Culture, science, modernity and politics admittedly define the very framework of our existence as one of the citizens of the state who has an organized pattern of belief system. These factors are obviously unpredictable at times that affects many facets …

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Healthcare policy-making is often regarded as one of the most significant task to perform. It involves greater demands of talent, skills and familiarity in the respective field, more especially with that of the line of Public healthcare and nursing profession. …

Health Policy Health policy is a set course of action undertaken by governments or health care organizations to obtain a desired outcome. Health care decisions will be made with or without nurses input. Patient care is a political endeavor. Essential …

Public policy that seeks to meet the basic needs of people who are unable to provide for themselves is ______ policy. social welfare The income level below which a family is considered to be poor is the: poverty threshold WE …

The right to healthcare is a basic human right. It is the prerogative of the government to provide medical services to its citizens. The particular government of the day has the mandate to allocate resources to the public health facilities …

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