Discussion: NURS 6050 Population Health

The burden of chronic diseases such as diabetes is becoming enormous therefore necessitating the development of policies and effective approaches to address them at the local, state and federal levels. The cost of diabetes management and treatment was estimated to be $245 billion in 2012 and it is postulated that it may continue to increase (Herman & Cefalu, 2015). Implementation of the Affordable Care Act policy meant to improve public health by increasing the access to health services by the population. The policy was developed in 2010 with the purpose of improving access to care, enhance quality of care delivery, reduce medical costs and provide new consumer protection. The policy resulted in the expansion of the Medicaid program. The design in this step was to fill gaps in the Medicaid eligibility and this means that the number of people benefiting from the program would significantly increase.

The cost projection for the ACA was $940 billion for the period between 2010 and 2019. In this plan, the health budget deficit would be reduced by $143 billion (Blewett, Planalp, & Alarcon, 2018). The insurance plan would reduce the cost of medication and make preventive healthcare affordable to the American populations (Herman & Cefalu, 2015). Importantly, patients suffering from chronic conditions such as diabetes require regular healthcare check-up and monitoring. With this program, the majority of the populations are able to access medical services as expected and this leads to improved prognosis. From the cost-effective aspect, the policy is financially sound.

The level of access to healthcare services depends on various factors including the socio-economic status. The ACA works to bridge the existing gaps between the rich and poor patients presenting with diabetes in terms of access to healthcare services. From an ethical perspective, the policy promotes equity. Healthcare professionals including the nurses are expected to serve the patients with equity and fairness. On the other hand, financial limitations may hinder the realization of such a goal and perspective in nursing practice. However, with the implementation of this policy, the disparity in health access is addressed. With the expansion of the Medicaid, the states would get 100% federal funding for the first three years after which, it would be reduced to 90% (Herman & Cefalu, 2015). Furthermore, various strategies have been incorporated under the policy to ensure that healthcare providers deliver the most beneficial and high-quality services to the patients.

The Scope of the Policy

Initially, the states administered the Medicaid programs as guided by the federal policies; though, they were

mandated to determine the eligibility, provider payment levels, and the benefits. The income levels for the eligibility were strict compared to the provisions in the new policy. Furthermore, no special considerations were made for patients with disabilities, elderly without dependent children and the non-pregnant women (Schembri & Ghaddar, 2018). Therefore, the policy was developed with collaboration between the state and the federal government. However, most of the regulations would be done by the federal government. For example, the states that failed to expand Medicaid to accommodate more people would lose federal funding. A larger portion of the healthcare funding would come from the federal government under the new policy.

The design and scope of the policy are well developed to meet the intended goal. The insurance agencies monitor the activities of the healthcare providers to ensure that they are giving their best in terms of quality service delivery. Various parameters such as the readmission within 30 days, number of days patient stay in the hospital and nosocomial infection rates among others have been used in monitoring the performance of the healthcare facilities (Hilliard, Liebenberg, Liebenberg, & Ruhland, 2018). Therefore, all institutions are obliged to comply with the provisions by offering high-quality care services to the patients and in the process improve their outcomes and minimize their spending. With the implementation of the new policy, the number of patients with diabetes covered in the Medicaid program increased significantly. This indicates that diabetes care would improve and the financial barriers limiting their access and utilization of the healthcare services reduced. On the other hand, despite the introduction of the policy, the number of people going for health screening has remained significantly low (American Diabetes Association, 2016). As a result, the measures to improved health outcomes for diabetes patients are thwarted because the number of undiagnosed diabetes patients is likely to remain high.

The Advocacy Strategies to Promote Access to the Benefits of the Policy

The realization of the benefits of the policy requires the provision of education to the public. Majority of the populations fail to go for health screening and testing because of the lack of knowledge on the importance of such an exercise. Provision of education is an important strategy for ensuring primary, secondary and tertiary health promotion (Konchak, Moran, O’Brien, Kandula, & Ackermann, 2016). First, educated populations are likely to embrace quality lifestyles that will limit the incidences of diabetes cases. Secondly, the education will aim at encouraging testing and screening behaviors among the populations to enhance the identification and early management of the diabetes conditions. Studies have shown that people from low-income regions and are covered with the Medicaid programs are more likely to be diagnosed with chronic illnesses and their conditions treated in time thus improving their prognosis.

From a Christian, professional and moral perspective, advanced registered nurses ought to advocate for and promote health as well as prevent diseases among the populations. By engaging in translational research, evidence-based practice measures are developed and customized to address specific health needs. Diseases are considered as the dissonance between an individual and their surroundings that affect the body, mind, and spirit. Holistic and biomedical approaches can be integrated to guide health promotion activities among nursing professionals. From the biblical perspective, health is a vital component of human life and that is why only whole animals would be offered for sacrifice in the Old Testament (McDermott-Levy, Leffers & Mayaka, 2018).

From the ethical and professional perspective, the nurses ought to comply with the ethical principles of nonmaleficence and beneficence among others. The ethical principles require that advanced registered nurse practitioners to engage all possible interventions in ensuring the most beneficial outcomes to the patients (Bastable, 2017). Health promotion activities aimed at promoting public health by minimizing diseases and suffering among the people. In the process, healthcare providers must understand the specific health needs of the defined populations. For example, the diabetes patients are in great need of the self-care skills which included proper adherence to the medication and observing an appropriate lifestyle.

Conclusion

            Therefore, the ACA has played an integral role in ensuring that diabetics in the United States receive high quality care. The scope and design of the policy is such that both the federal and state governments participate in the implementation of the ACA. The entire process has influenced the role of Advanced Practice Nurses as they work to promote it and advocate for its implementation.

References

American Diabetes Association. (2016). 1. Strategies for improving care. Diabetes Care, 39(Supplement 1), S6-S12.

Bastable, S. B. (2017). Nurse as educator: Principles of teaching and learning for nursing practice. Burlington, MA: Jones & Bartlett Learning.

Blewett, L. A., Planalp, C., & Alarcon, G. (2018). Affordable Care Act Impact in Kentucky: Increasing Access, Reducing Disparities. American Journal of Public Health, 108(7), 924–929. https://doi.org/10.2105/AJPH.2018.304413

Herman, W. H., & Cefalu, W. T. (2015). Health policy and diabetes care: is it time to put politics aside?. Diabetes Care, 38(5), 743-745.

Hilliard, J. I., Liebenberg, A. P., Liebenberg, I. A., & Ruhland, J. (2018). The Market Impact of the Supreme Court Decision Regarding the Patient Protection and Affordable Care Act: Evidence from the Health Insurance Industry. Journal of Insurance Issues, 41(2), 135–167

Konchak, J. N., Moran, M. R., O’Brien, M. J., Kandula, N. R., & Ackermann, R. T. (2016). The state of diabetes prevention policy in the USA following the affordable care act. Current diabetes reports, 16(6), 55.

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical Principles and Guidelines of Global Health Nursing Practice. Nursing Outlook, 66(5), 473-481.

Schembri, S., & Ghaddar, S. (2018). The Affordable Care Act, the Medicaid Coverage Gap, and Hispanic Consumers: A Phenomenology of Obamacare. Journal of Consumer Affairs, 52(1), 138–165. https://doi.org/10.1111/joca.12146