Assignent Solutionnurs

Respond to at least two classmates’ posts offering additional information, a different perspective, links to relative articles/websites, etc.
Reference and cite your sources per APA format.
Post 1:
Cost, access, and quality remain primary concerns within the United States health care system. The United States continues to struggle with growing health care expenditures, leading the globe in healthcare spending at $3.0 trillion dollars annually or 17.5% of gross domestic product (GDP) in 2014 (Shi & Singh, 2019). Although the United States spends more on health care than any other country, our health care system continues to lag behind other developed countries in regard to quality, access, efficiency, equity, and healthy lives. This underperformance by the U.S. health system is in large part due to the lack of universal health care coverage, which translates into disparities in access to care (Davis et al., 2014). Individuals who are uninsured tend to delay seeking medical care when needed due to cost. In turn, this results in higher utilization of emergency room visits and greater expenditures for medical illnesses that could have been prevented or treated more cost-effectively had that person had better access to primary and preventative care (University of Utah Health, 2015).
Unfortunately, expanding access to care for the uninsured would increase health care expenditures, as cost and access go hand-in-hand. The relationship between cost and access is one of the major reasons why attempts to implement universal health care coverage in the United States have failed (Shi & Singh, 2019). Growing national health expenditure (NHE) is a rising concern in the United States, as it means that Americans must forego other goods and services in exchange for health care services. An increase in NHE also translates into higher insurance premiums and decreased affordability of doctor’s visits and pharmaceuticals (Shi & Singh, 2019).
A proven response to growing NHE is to increase the utilization of mid-level providers (NPs and PAs) to provide more cost-effective care. Cost effectiveness of NPs begins with their academic preparation, with total tuition cost for NP education costing less than one year’s tuition for medical school. The hourly cost of a NP is also one-third to one-half that of a physician. Further, cost-related outcomes such as length of stay, emergency visits, and hospitalizations for NP care are equal to those of physicians (American Association of Nurse Practitioners, 2013). Estimates of labor cost savings per primary care visit using NPs has been estimated to be between 5-9%. Additionally, utilizing NPs more frequently in health care delivery increases visit capacity, which allows for greater access to care (Roblin et al., 2004).
I interviewed a former colleague named Emily Rakestraw, MSN, RN who states that she believes the most important issue in health care today is access to care. Emily is a nurse leader at a local hospital and serves as a charge nurse in the medical/surgical department. Emily oversees care in the medical/surgical department and also provides direct nursing care to patients when needed. Emily states that inappropriate emergency department (ED) visits and hospitalizations remain a huge issue and burden to the health care system. Per Emily, many of the ED visits in the hospital in which she works are for issues that are not true emergencies or illnesses that could have been prevented or treated in an outpatient setting, had the patient sought care sooner. Emily states that patients who use the ED for treatment of chronic and acute minor illness often do so because they do not have a primary care provider or cannot afford to be seen in an outpatient setting.
Studies on inappropriate emergency department use point to a 20-40% prevalence. Primary factors associated with inappropriate ED use include younger age, female gender, lower socioeconomic status, not having a regular physician or regular source of care, and difficulty in accessing primary care. Inappropriate ED use leads to a variety of consequences to the health care system. It increases total health expenditure, hinders access to the ED for true emergencies, and leads to care that is provided more hastily without the benefit of continuity of care and follow-up (Carrett, 2009)
Post 2:
Mid-level providers such as nurse practitioners can increase access to care and quality of care while decreasing medical costs in primary care. The demand for primary care services is rising as the United States’ population increases in age. Primary care has been facing challenges due to the decreasing number of primary care physicians especially in rural areas (Buerhaus, 2019). Nurse practitioners are capable of filling these primary care shortages by providing care to patients in areas in order to increase access to medical care. Typically nurse practitioners are paid at 85 percent compared to primary care physicians per Medicare (Buerhaus, 2019). Therefore, patients are able to pay less in medical costs while receiving satisfactory primary care from nurse practitioners. Furthermore, patients convey increased levels of satisfaction with their primary care provided by nurse practitioners (Shi & Singh, 2019). According to Shi & Singh (2019), “a substantial body of research evaluating the quality of primary care provided by MLPs shows that these providers perform as well as physicians on important clinical outcome measures, such as mortality, preventable hospitalizations, and improvement of patient health” (p. 159).
I interviewed a previous colleague named Matthew Lee, MSN, FNP that has worked numerous years as a FNP in the emergency department and is now in an urgent care setting. He states that access to medical care has increased if the patient can afford their co-pay or deductible. However, if patients are underinsured or on a tight budget, the access can seem less available to these patients. By using nurse practitioners in rural areas or where medical access is limited, it can improve medical access and lower medical costs to the patient. Below are his answers to the following questions: (1) What do you think is the most important issue (related to the cost, quality, and access framework) in health care today?, (2) How does he/she see the cost, quality, and access framework in his/her position/job?, and (3) What role, if any, does this person play in health care policy, health care finance, and the health care delivery system?
What do you think is the most important issue (related to the cost, quality, and access framework) in health care today?
I would like to discuss the accessibility of healthcare first. As far as access goes there has never been a time in history where healthcare access has been more readily available. Anyone can go, at any time of the day, to receive healthcare. Many people, wrongly, use the emergency department (ED) for such care from typical childhood illnesses, to medication refills on medications for chronic health conditions, and to legitimate emergencies. Not only this, but anyone, with insurance or enough cash-on-hand, can also go to any of the thousands of urgent care clinics for many of the same care options. The problem is that outside of true life or death emergencies many, specifically uninsured and financially strapped, lose this availability or at least the perception of this availability. Cost, unfortunately, is the biggest driving force in healthcare and that is the reason so many are limited to what care they can receive and in many instances the quality of that care. Going back to the ED, if a hospital has to see and admit a specific number of patients per day to maintain a certain level of gross income to keep investors happy then administrators are pressed to force providers to push through as many patients as possible, and this can, and does, significantly reduce the quality of care that is available. This occurs throughout the hospital and outpatient settings to increase patient numbers so that businesses can maximize profits.
How does he see the cost, quality, and access framework in his position/job?
I am one of the luckiest nurse practitioners alive. I get to work for a company that pushes numbers, but also limits the number of patients that can be seen by providers in a single shift. The company is a mobile urgent care (UC) company, and they accept many insurances and charge the insurance companies just like a brick-and-mortar UC would. The difference is this company limits patient numbers so that quality care is delivered and if someone doesn’t have insurance the maximum out-of-pocket cash charge for a patient is no more than $275. By accepting most insurances, it improves access, especially with patient populations who do better in their home environment (patients with autism, dementia, bed-bound stroke pts…), and by limiting the out of pocket charge it improves that perception of access that less financially stable people would otherwise have if OOP costs were that plus charges for exams, tests, and treatment.
What role, if any, does this person play in health care policy, health care finance, and the health care delivery system?
I personally have little to do with healthcare policy or healthcare finance. However, I am a mid-level provider who delivers care autonomously another provider creating protocols that I must follow. I am able to discuss with the patient and their family what treatments are best for them and help them find treatments/options that fit their budget/belief systems. As far as delivery I am lucky enough to get to deliver care to patients in every sense of the word. I have taken urgent care to nursing homes, peoples’ houses, and even once to a patient at a Community Outreach Center in downtown Chicago.