Introduction
The growing workforce shortages is a major challenge facing the healthcare industry in the U.S. Currently; the nation is struggling with improving the healthcare system to take care of the increasing number of patients and to provide better health care services at an affordable price. Primary care providers work hard to look after their patients as they influence the treatment, diagnosis, prescriptions and the overall quality of healthcare services. However, Americans especially those in rural areas are at risk of getting inadequate healthcare services due to the present and the ever increasing health workforce shortages. Currently, the U. S. is trying to reform the health care industry through the Patient Protection and Affordable Care Act that was signed into law in 2010 (Institute of Medicine, 2010). Such reforms are meant to increase the productivity of the primary care providers and to increase the healthcare workforce capacity.
This discourse seeks to analyze the Patient Protection and Affordable Care Act (PPACA) and how it attempts to address both the short-term and the long-term elements of health care workforce capacity and productivity. The Patient Protection and Affordable Care Act, also known as the Obama care or the Health Insurance Reform, was signed into law in 2010, and it signifies a major regulatory overhaul of the nation’s healthcare system.
Description of the policy
This law seeks to put American citizens in charge of their health care and provides them with the flexibility and firmness needed to make up-to-date decisions about their health. The PPACA was endorsed to make health care services affordable for both the citizens and the government and to improve the quality of healthcare services. It is aimed at reducing the cost of health insurance and lowering the rate of the uninsured (Bodenheimer, 2010). This policy seeks to address the long-term and short-term elements of the capacity and productivity of the healthcare workforce. It is aimed at trying to find solutions to the ever increasing workforce shortage in the health industry in the U. S.
History of the policy
This health policy was championed in 1980s when the Conservative Heritage Foundation proposed a single payer health care system that would lead to individual responsibility. Previously, the government had to chip in and pay for those who could not afford the health care services. In 2006, Governor Mitt Romney passed the insurance expansion bill in his Massachusetts state. This bill covered the individual health insurance mandate and the insurance exchange. Massachusetts successfully implemented a policy and this lead to the introduction of the Healthy Americans Act that included the individual mandate and the state health help agencies in 2007. In February 2009, President Obama announced to work with Congress to come up with the policy that would reform the health care industry. By July 2009, the House of Representatives had already approved a number of health care bills. Lobby groups and the public were also involved in making opinions on the approved proposals (Institute of Medicine, 2010). In November, the Affordable Health Care for America Act was passed by the House of Representatives and then forwarded it the Senate. The Senate used the Internal Revenue Code bill to amend the Affordable Health Care Act. The bill was amended to combine both the health care and the financial issues leading to the creation of the Patient Protection and Affordable Care Act (Institute of Medicine, 2010). The PPACA bill was passed to be amended by the Health Care and Education Reconciliation Act. President Obama signed the Affordable Care Act into law in March 2010 together with the Health Care and Education Reconciliation Act.
Effectiveness of the policy
The Affordable Care Act (ACA) has led to an increase in the number of Americans who have medical insurance cover. The increased demand of individuals for health care has led to a shortfall of health professionals, and the shortage is likely to grow in the coming years (Carlson, 2010).
The Patient Protection and Affordable Care Act (PPACA) has provisions that seek to improve the accessibility of primary care services. The policies included in this law attempt to address the short-term and the long-term elements of the primary care workforce capacity and productivity. The strategies put in place by this law include the increase in temporary payment rate for primary care services. By raising the reimbursement, the law has been able to incentivize the primary care providers to serve the Medicaid patients. The increase ensures that healthcare providers serve more citizens and offer more healthcare services. This aspect will lead to an increase in the capacity of the health workforce. This law has provisions that seek to expand the healthcare workforce capacity. These provisions include an increase in funding for scholarships and educational loan forgiveness for medical practitioners who are ready to work in underserved and rural areas (Dower, 2011). In the long run, more practitioners will be attracted to the industry hence curbing the shortage in workforce capacity. Moreover, the law has strategies that encourage more graduates to work in the rural areas, and it provides opportunities for training to those who are in primary care. By doing so, the clinicians are able to gain more skills and are, therefore, more productive (Bodenheimer, 2010). The law has adopted medical technology increasing the number of physicians. The advancements in medical technology have extended the therapeutic and diagnostic alternatives for the medical practitioners. It has promoted the call for primary care services and increased the number of primary care providers. More patients under medical cover are now able to consult medical practitioners who can provide most informed, sophisticated treatment. The law seeks to have practice model modified to incorporate new workers into the care delivery field. This incorporation is meant to increase the capacity. The PPACA has created the Accountable Care Organizations (ACOs) that are organizations that are responsible for the cost, quality and care of patients who are under Medicare. The Accountable Care Organization receives a share of savings when the real per capita expenses are below their stated standard amount. This aspect helps in improving the overall productivity of the primary care providers (Institute of Medicine, 2010). The Patient Protection and Affordable Care Act has put in place programs such as the collaborative care networks that are based in the local communities to enable individuals with low incomes to access medical services and medical centers. This law aims at promoting the prestige and significance of primary care among the medicine students. It seeks to experiment with primary care providers who are at mid-level status. As a result, there has been in increase in graduating medical institution student selection of primary care residencies. The law supports primary care training in academic settings. It seeks to award funds to operate, develop and plan programs in primary care. The policy also provides financial support to medicine students and faculties to improve development in primary care and physician assistant programs. The policy is aimed at hiring students who are more willing to serve in the rural and underserved areas (Dower, 2011). The PPACA has a strategy that redistributes residency positions when vacancy arises and directs that a large portion of the new Medicare residencies be in primary care. It dictates that the teaching hospitals and academic medical centers may acquire funds for primary care residency. The focus on primary care residency has a higher productivity than academic programs because the residents are able to provide and deliver patient care while creating revenue for the hospitals and health care centers during their training.
The affected group by the shortage
The health workforce shortage mainly affects citizens who are under Medicaid program and those who reside in the rural and underserved areas. Public health workforce shortage does not only affect service delivery in health department but also other professions. The effect spill over to other professions such as health education sector, biostatic and medicine, health agencies at the local and state levels where severity is felt in the nursing unit, epidemiology, laboratory science and environmental fields(M. Norbury, 2011). Different departments and sectors are affected by the shortage in the workforce. The most affected groups are discussed as follows:
• Public health nursing-this is an important group in the community health. The experts in this area play a significant role and provide very essential services. The health provider in this department provides services such as health education about preventive measures and nutrition, organization programs and as well as working hand in hand with the community in to develop proper ways of prevention among the communities that are at high risks of infections. However, the number of worker in this area has experienced shortage leading to a number of challenges. A survey involving b37 states conducted by ASTHO/NASPE indicate that health nursing profession is largely affected the workforce shortage(E. O'Neil and C. Dower, 2011). A numbers of issues are suggested to be contributing to the increasing shortage including low salaries, lack of competence and lack of flexible schedules for the nurses.
• Epidemiologists are also affected by the shortage. This group comprises of experts who determine the causes of diseases, disability and other health related problems. Their job involves tracking of diseases and developing various ways to prevent, contain and control the diseases. The emergence of infections such as influenza and West Nile Virus has made the filed more challenging and demanding. The survey by the NASPE found that nearly half of the 37 states involved in the survey are faced with a serious shortage of epidemiologists.
• Laboratory science is also affected much by the shortage. Out of the 37 states engaged in the survey, 11 states are faced with a crisis in the areas of laboratory science. There are very few experts who do the testing and diagnosis of diseases in the public health sectors. The number of tests medical test is increasing, but the technicians and laboratory scientist are very few.
• Environmental health sector is equally affected by the shortage of workforce. This department comprises professionals who inspect the quality of air, water, pollution and monitor use of land. It also deals with the monitoring of toxic substances and promotes healthy housing. Despite is importance; environmental health sector is highly affected by the workforce shortage that is currently experienced in the health sector. In fact, environmental health is the second most common profession in health department. It constitutes almost 4.8% of the public health workforce. It is one of the moat affected sectors in health by the workforce shortage.
These groups are among the most affected by the workforce shortage that is experienced in the health sector in the U.S. In fact; over twenty-five percent of the U.S population is made up of the underrepresented groups. Nevertheless, this group only constitutes ten percent of the health profession in the federation with a very dismal growth rate. It is, therefore, worth mentioning that the workforce shortage in the health sector is a menace to the entire federation. Most regions are underserved due to the inadequate health professionals compared to the population.
The future of this policy
Several amendments are being made to the Patient Protection and Affordable Care Act to increase the health workforce productivity and capacity. The amendments are as discussed below.
• Making reforms on payments. New methods of payment need to be put in place to increase health workforce capacity and ultimate yield. Methods such as capitated payments that threaten the primary health care providers by the fact that they are to pay for the health care services and other care management models will boost the creation of teams that can share the responsibilities that come with care (Institute of Medicine, 2010). The care groups will deliver more primary health care services to more citizens compared to an individual working alone.
• The primary care practitioners should be allowed to initiate care that is currently executed by the health specialists. These care coordination agreements will help to curb the waning care disintegration and promote care delivery at a lower cost improving their efficiency.
• According to the Council on Graduate Medical Education, both the nation and state governments need to increase the number of residencies in departments with shortages for example, the psychiatry and adult primary care departments. Currently, there are no mechanisms in place to respond to health workforce shortage (Carlson, 2010). There is a need to amend the law to create a plan for the health workforce. Lobby groups are for the idea that the law should include strategies that will be pursued to handle the needs of the primary care providers.
• There are proposals that the law should be linked with the migration and foreign affairs policies to address the issue of health workforce shortage. Partnering with the World Health Organization (WHO) will also help in trying to solve this problem.
• There is need for modernization in the primary care training to promote the graduation of more competent primary care providers to handle the ever increasing number of patients in the U. S. The modernization will promote the retention of more competent primary health care providers in the underserved and rural areas (Carlson, 2010). There is a need for provisions for the scope of care provided by a licensed primary care practitioners.
Conclusion
References
Bodenheimer, T. a. (2010). “Primary Care: Current Problems and Proposed Solutions. Health Affairs, 9-13.
Carlson, J. (2010). Primary Dispute. Modern Healthcare, 20-25.
Dower, C. a. (2011). Primary Care Health Workforce in the United States. New Jersey: Princeton.
E. O'Neil and C. Dower, “. (2011). Primary care health workforce in the United States,” The Synthesis Project Research Synthesis Report. New Jersey .
M. Norbury, S. W. (2011). Time to care: tackling health inequalities through primary care. Family Practice, vol. 28, no. 1, pp. 1–3.
