Health Care Delivery Models and Nursing Practice
Health Care Delivery Models and Nursing Practice
According to Kos (2019), healthcare delivery models focus on financing, providing, localization, and regulation of health care. Examples of these models include the Bismarck, Beveridge, out-of-pocket, and national health insurance models (Kos, 2019). The best healthcare model is one that ensures increased access to healthcare services at cost-effective prices (Kos, 2019). This paper examines changes implemented to reform the health care system of the USA and identifies the role of the nurse in this reformed system.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA) was enacted in 2010. ACA is a law aimed at achieving comprehensive reform in the US healthcare system (McIntyre & Song, 2019). The law has three major goals. The first one is to make affordable health insurance available to a larger population. This is accomplished by reducing costs for households whose incomes fall between 100 percent and 400 percent of the federal poverty level (Chait & Glied, 2018). The second goal is the expansion of the Medicaid program to include adults whose income is lower than 138 percent of the federal poverty level (Mazurenko et al., 2018). The third goal is to advocate for innovativeness in the healthcare delivery systems to minimize healthcare costs (Chait & Glied, 2018).
The other provisions of ACA aim at increasing insurance protection of the consumer, advocating for preventive health, and improving the quality of care. Consumer insurance protections are increased by removing lifelong monetary caps on coverage and expanding coverage to include children with underlying conditions (McIntyre & Song, 2019). Additionally, insurers cannot rescind coverage unless it was obtained by fraudulent means (McIntyre & Song, 2019). ACA established the Prevention and Public Health Fund to facilitate promotive and preventive health services. Provisions such as healthcare informatics, healthcare research, and Medicare and Medicaid care coordination aim to improve the quality of healthcare (McIntyre & Song, 2019).
Findings demonstrate that the implementation of the ACA increased access to healthcare services. Data from 2016 indicated that approximately 20 million Americans had accessed health insurance after the implementation of the ACA (Chait & Glied, 2018). Accordingly, the percentage of uninsured people dropped to about 9 percent. The increased access to healthcare is attributed to the expansion of Medicaid and the elimination of existing limitations (Chait & Glied, 2018). An example of such as limitation is the coverage of children with underlying conditions. Financial protection was achieved by significantly lowering out-of-pocket healthcare costs (Chait & Glied, 2018).
The ACA has a significant impact on nursing practice, including its responsibilities and roles. ACA advocates for coordination and a continuum of care to increase the quality of care. Nurses, as key stakeholders in patient care, are required to uphold care coordination that entails proper scheduling of tasks to ensure patient safety. Care coordination is important due to the increase in access to healthcare services (Luther et al., 2019). The other aspect is innovativeness to minimize healthcare costs. The role and responsibilities of nurses transformed to embrace nurse informatics. Nurse informatics entails the use of informational technology and computerized systems to process patient data to enhance patient safety (Peltonen et al., 2019). ACA increased transformational leadership in nursing practice to support innovativeness, minimize healthcare costs, and ensure patient safety.
Quality Measures and Pay for Performance
According to Pandya et al. (2020), quality measures are used to assess the efficiency of service delivery to patients. This is done by comparing specific outcomes against established national or state benchmarks (Pandya et al., 2020). This enables healthcare facilities to assess and determine underperforming indicators. By so doing, relevant interventions are put up to address the underperformance and increase the quality of care (Pandya et al., 2020). Better quality of care is associated with an improvement in patient outcomes.
According to Pandya et al. (2020), pay for performance links insurance reimbursements to the outcomes of specific metrics. This includes patient outcomes, the use of evidence-based practices, and the level of patient satisfaction. This is a value-based model that requires healthcare providers to uphold quality practices to achieve better patient outcomes (Pandya et al., 2020). Underperformance in metrics can lead to penalizations and decreased reimbursements. The Centers for Medicare and Medicaid Service have adopted this value-based approach through various programs, such as the h