Posted: October 3rd, 2024

Nursing Leadership Health Policy Essay

Nursing Leadership Health Policy Essay.

Medicare is one of the biggest providers of healthcare funding in the United States, and covers around half the health costs of almost 60 million people (Mason, Leavitt, & Chaffee, 2013). This extensive coverage highlights the critical role Medicare plays in the healthcare system. Despite this, the original 1965 Medicare legislation contains anti-discrimination text that means that often, the nuances of health conditions are not covered (Mason et al., 2013). This lack of specificity can lead to gaps in essential healthcare services for certain conditions. This singular approach means that individuals with diabetes cannot get eye tests covered, due to the fact that eye tests are not covered under Medicare.

Despite this, regular eye tests are recommended for individuals with diabetes and is part of living with this chronic condition, meaning that Medicare is not providing the essential services that it needs due to a lack of nuance in the wording (Mason et al., 2013). This gap in coverage can lead to increased health risks for diabetic patients. Diabetics currently have to pay 20% of the cost of these eye exams and in a hospital setting are liable for a copayment (Mason et al., 2013). This financial burden can deter individuals from seeking necessary care. The purpose of this paper is to explore a policy change designed to improve the specificity of Medicare for those with long-term health conditions.

The House of Representatives have recently passed a bill that helps Medicare to provide more clinically nuanced benefit systems in the Medicare Advantage Program (Mason et al., 2013). This legislative effort aims to address some of the existing gaps in coverage. This is due to the fact that anti-discrimination laws written into the original Medicare protocol do not allow for nuance in coverage (Mason et al., 2013). The rigidity of these laws often limits the scope of care available. Despite this, there is still room for improvement in terms of improving the nuance of Medicare to ensure that people are getting the services that they need. Diabetics, for example, now have some elements of a yearly eye test for glaucoma covered, but still have to pay a copayment in some scenarios (medicare.org, 2016). This partial coverage is a step forward but not a complete solution. Physicians may also recommend that a diabetic patient gets eye tests more regularly than yearly, or other eye-related testing, which is not covered by Medicare despite the fact that diabetes is a chronic condition (mediare.org, 2016). This gap in coverage can lead to inadequate monitoring of the condition. The proposed change is to allow for more nuance in the development of Medicare protocol in terms of long-term conditions.

Chapter 4 of the Medicare provision bill currently contains a passage that aims to prevent discrimination. This passage is crucial for ensuring equitable access to healthcare services. The current wording of this passage aims to prevent discrimination, but the proposed change would allow for discrimination on the basis of providing more nuanced healthcare. This change seeks to balance equity with the need for tailored healthcare solutions. The current wording for the bill is: “An MAO may not deny, limit, or condition enrollment to individuals eligible to enroll in an MA plan offered by the organization on the basis of any factor that is related to health status, including, but not limited to the following: claims experience; receipt of health care; medical history and medical condition including physical and mental illness, genetic information; evidence of insurability, including conditions arising out of acts of domestic violence; or disability” (cms.gov, 2016). This comprehensive list aims to protect individuals from unfair treatment. The proposed change would include an additional clause that would allow for discrimination based on the better provision of health services to those that fulfill the above criteria. This aims to enhance the quality of care for those with specific needs. The change would be worded as follows: “Discrimination based on the above factors with the aim of specifically providing better services to those that fall into these categories is accepted. The provision of eye tests to those with long-term conditions that require additional monitoring is allowed, as is promotion of health services that can benefit marginalized populations.”

The first step of implementation is to research countries that have full healthcare coverage, like the United Kingdom. This research can provide valuable insights into effective healthcare policies. Understanding how the National Health Service bills are worded can help to understand what type of information needs to be provided in order to make Medicare work more efficiently in the United States. This comparative analysis can guide policy adjustments. The second step is lobbying for change. Nurses need to be involved in the political process and understand who needs to be approached in order to get this additional passage added to the Medicare bill. Their involvement is crucial for advocating patient-centered care. It will be useful to know who is most likely to support better coverage for the marginalized under Medicare and use this individual as a public advocate for the proposed change. Identifying key stakeholders can enhance the effectiveness of lobbying efforts.

This can also involve researching the different levels of care in different states to assess how the change would work on a national/federal level. This assessment can help tailor the policy to diverse healthcare environments. It can also be useful to understand which parts of the bill will be affected through the change. This understanding is essential for anticipating potential challenges. The final stage is preparing hospital staff for the change after it has been passed. This preparation is key to ensuring smooth implementation. This involves training on Medicare provision and how the change is going to affect incoming payments from Medicare patient. Proper training can minimize disruptions in service delivery. Billing departments need to be notified in order for the bill to work successfully in real-life scenarios. Effective communication with billing departments is crucial for operational success.

The two main advocates for this change are likely to be federal legislators, who need to understand the proposed change and make economic concessions for how the bill will affect national finances and provision of Medicare (Mason et al., 2013). Their support is vital for legislative success. These individuals need to lobby for the change in the Senate to ensure that it is passed in an appropriate manner. Strategic lobbying can facilitate the passage of the bill. The second main advocate is national state nursing organizations, who are likely to support the change in that it will provide better services that are appropriate for those who have certain life-long conditions and need extra care to be covered by Medicare. Their advocacy can amplify the voices of those affected by the policy. These organizations will be influential in making changes occur. Their influence can drive meaningful reform. I have not voted for the individual in office that will be responsible for making the change, but lobbying is still an option. Civic engagement remains a powerful tool for change. It will be interesting to see how national nursing organizations approach the change. Their strategies could set a precedent for future advocacy efforts.