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Healthcare Reform and Role of the ANP
Psychiatric mental health nursing is the profession working for people having mental illnesses such as bipolar disorder, schizophrenia, and other such problems. It works on managed care that is the system of utilizing finances in the most efficient way for appropriate and managed health care delivery. In the managed care, nurses assure the cost effectiveness by developing clear boundaries for planning, targeting, and delivering needed services. Funding for advanced nursing practice may come from the government and/or other healthcare organizations. Researchers have reported certain factors that may become barriers in the implementation of advanced nursing practice such as (Kleinpell et al., 2014):
Management of healthcare and funding processes, particularly the processes of payments for healthcare providers. Usually, nurse practitioners receive lower wages as well as reimbursement fees as compared to physicians, thereby making it difficult for them to financially sustain a primary care practice (Hain & Fleck, 2014).
Professional interests of healthcare providers,
The capacity and quality of education and training.
Most importantly, the impact of laws and policies on scope of practice. According to a report of the Institute of Medicine (IOM), some states have severely restrictive scope-of-practice regulations for nursing profession. These changes in policies from one state to another include changes in payer policies and practice opportunities (Hain & Fleck, 2014).
In the healthcare reform, nurses can help in expanding the healthcare framework, thereby positively affecting the cost, quality, and access to healthcare, and incorporating the organizational arrangements in the healthcare delivery.
Healthcare Policy
Healthcare policy refers to the compilation of authoritative and dependable decisions made by government that are related to health and the pursuit of health. Usually, healthcare policy helps in the development of plans for managed care and health insurance. Health insurance facilitates in coverage of medical and/or surgical expenses that are incurred by the insured. All people are required to have some healthcare coverage, and this coverage can be achieved in different ways such as eligible employer sponsored plan, Medicaid, Medicare, and other such plans.
Each carrier or insurance options have has its own selected network of preferred doctors, hospitals, or healthcare providers. Therefore, insured members often have to go for carrier’s preferred provider list. Usually, managed healthcare plans can be of two types; Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). In HMO, members of the plan are able to choose the physician from a list of approved healthcare providers, which may result in lowering the premiums and/or decreased copayments. On the other hand in PPO, members have multiple choices in healthcare and/or healthcare providers, and members pay a premium on monthly or quarterly basis to cover their medical services.
Usually, healthcare policies help in improving healthcare by providing incentives for patients and healthcare providers (Rosenthal, Lu, & Cram, 2013), and insurances are among the ways to improve healthcare by providing financial support. Moreover, healthcare reforms help in eliminating the rules and regulations that may hinder the cost-effective use of nurse practitioners and managed care (Bauer, 2010).
References
Bauer, J. C. (2010). Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness. Journal of the American Academy of Nurse Practitioners, 22(4), 228-231.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).
Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., . . . Beauchesne, M. (2014). Addressing issues impacting advanced nursing practice worldwide. Online Journal of Issues in Nursing, 19(1).
Rosenthal, J. A., Lu, X., & Cram, P. (2013). Availability of consumer prices from US hospitals for a common surgical procedure. JAMA internal medicine, 173(6), 427-432.
