Nursing Shortage Assignment Paper Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.
Introduction
The contemporary U.S. Health Care System is considered to be distinctly sophisticated, unequal, characterized with uneven quality and costly (Joel, 2017). Originally private, the current health care delivery system in the United States of America is a complex mix of both public and private partnerships following a series of reforms aimed at addressing persistent market failures in the financing, access and delivery of superior quality, safe and affordable care to the majority of people, especially vulnerable populations (Salmond & Echevarria, 2017). Although major legislative and institutional reforms over the last two decades have contributed to enhanced coverage and access to health care, these developments have been criticized for their inability to contain or reduce costs as the major impediment to universal access to quality care in the long-term perspective (Jay & Priya, 2018; DPE, 2016). Combining relevant empirical and conceptual evidences, the paper discusses the access, cost and quality of health care delivery as well as quality measurement initiatives adopted within the U.S. Health Care system. The overall discussion also reflects on the relationship between quality measures and evaluation and role development of the Advanced Practice Nurse (APN). Nursing Shortage Assignment Paper
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The Access Component
According to Joel (2017), access is described as the capacity to receive care, health care and/or related services and goods. Whilst the rising demand for affordable and quality care has pushed many of health-care reforms and role developments for the APN, access to health care services is also considered to be an important variable in determining health status and outcomes of care in different settings. Sezer and Bauer (2017) argued that access to healthcare and coordinated care remains a major issue affecting millions of vulnerable populations in rural and urban environments. Whilst a series of special payment initiatives (Medicare, Medicaid) have since been adopted to enhance access to healthcare across the continuum of care, millions of Americans could be categorized as vulnerable populations due to persistent lack of access to primary care services; high rates of underinsurance and insurance; high unemployment rates; low health literacy levels; cultural differences (linguistic, cultural and social barriers); socio-economic differences (poverty), socio-demographic differences (age, ethnicity) and environmental challenges (air pollution, unsafe streets, among others) (Maxey et al 2015). Salmond and Echevarria (2017) insisted that, the health insurance in the country is characterized by uneven coverage and rising healthcare premiums, with estimates showing that close to 32 million Americans are currently uninsured, majority of whom are poor and often minorities. Whilst adoption of the Affordable Care Act (ACA) paved the way for expansion of health insurance to American adults, the absence of comprehensive health insurance is projected to cost the United States a significant amount of financial resources to the tune of $280 billion every year due loss of productivity, reduced human capital and other associated costs (Agency for Healthcare Research and Quality, 2016). International Council of Nurses (2015) added that more than forty million workers (in both full-time and part-time employment) in the United States have no access to health and insurance benefits at their respective workplaces, and this is an issue that has greatly undermined access to quality, safe and affordable care among the vulnerable populations with pre-existing conditions.
The Cost component
The high cost of healthcare is also regarded to be another major issue affecting the performance of the healthcare system in the United States (Joel, 2017; Agency for Healthcare Research and Quality, 2016). Whilst seeking to determine whether the disproportionately higher cost of health care represents a manifestation of corporate greed, Mathur and Srivastava (2016) found out that, the country spend more than $3 trillion annually on health care alone, representing close to 18% of the Gross Domestic Product (GDP), and approximately $9,300 on each individual every year in the form of healthcare costs. The study noted that since 2010, a growing number of U.S.-based pharmaceutical companies have actively increased the prices of life saving drugs including Daraprim for treatment of HIV patients (from $13.50 to $750 per tablet), EpiPen utilised for treatment of anaphylactic shock (from $57 to $415 for a pack of 2 EpiPen), among others (Mathur & Srivastava, 2016). Whilst the U.S. federal government has been in the p