Chapter 23

Chapter 23
Health Policy and Politics: Get
Involved!
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Health Policy
Nurses’ Involvement in Health
Policy and Political Action
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 State and federal governments play an increasingly important role in
health care, especially as federal and state governments and
multiple private players embark on health care reform
 Nursing practice is directly affected by health policy development
which is, in turn, affected by the political action of citizens—nurses
and many, many others
 Patient safety and quality; access to affordable health coverage and
services; and costs, value, and outcomes of services have become
a major debate among policymakers
 National attention on nurses and nursing has intensified—our
numbers, education, scope of practice, and overall value to the
health care system
Nurses’ Involvement Has Become
More Intense

 Patient care and nursing practice is a political
endeavor
 Essential that nurses are involved to ensure that
the nursing perspective is represented
Health Care Decisions Will Be
Made with or without Nurses’ Input

Health Policy
What Is Health Policy?

 Set course of action taken by governments or health
care organizations to obtain desired health outcome
 Private health policy is made by health care
organizations such as hospitals and managed care
organizations
 Public health policy refers to local, state, and federal
legislation; regulation; and court rulings that govern the
behavior of individuals and organizations in the provision
of health care services
Definition

 Local health policy
 Cities or counties offer a variety of health care
services to meet the needs of their residents
 Examples include free or reduced-rate immunizations,
tobacco-free public buildings, safe drinking water,
enforcement of seat belt and child restraint laws, and
provision of an emergency medical system
Health Policy at the Local, State,
and Federal Levels

 State health policy
 Governs nursing through nurse practice act
 Provides “invisible services” through regulatory
activities
• Maintaining a safe meat supply through livestock inspections
• Ensuring safe food storage and preparation in restaurants
• Ensuring that health care facilities provide safe, quality care
and Federal Levels (cont'd)

 State health policy
 Pays for health care services through various
programs:
• Medicaid and State Children’s Health Insurance Program
(SCHIP), which are partly funded by federal funds
• Other indigent care programs, which vary from state to state
 A key piece of the health care reform legislation is the
opportunity for states to develop State Health
Insurance Exchanges (SHIEs)—a set of state
regulated and standardized health care plans from
which individuals may purchase health insurance
eligible for federal subsidies
Health Policy at the Local, State, and
Federal Levels (cont'd)

 Federal health policy
 Funds health-related research
 Funds education for health professionals, including
nurses and physicians
 Pays for health care through Medicare, Medicaid,
SCHIP, and the Veterans Administration health care
system
 Plays a monumental role in shaping nursing practice
 Passage of the Patient Protection and Affordable
Care Act (PPACA) (2010)

 Federal policy that shaped nursing practice
 Nurse practice acts and registration of nurses
(implemented in most states by 1910)
 Sheppard-Towner Act (1921)
 Hill-Burton Act (1950)
 Medicare program (1965)
 Renal disease program (1972)
 Diagnosis-related groups (DRGs) (1983)

Health Policy
Health Policy Development
12Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Complex, dynamic process; occurs in various
ways
 Enactment of legislation and accompanying rules and
regulations that carry the weight of law
 Administrative decisions made by various
governmental agencies
 Judicial decisions that interpret the law
Definition

 Involves numerous individuals and groups
 Elected officials
 Officials from governmental agencies
 Experts in the related area
 Stakeholders such as corporate representatives
 Representatives from special interest groups
 Other affected citizens
Definition (cont'd)

 Involves all three branches of government
 Executive
 Legislative
 Judicial
Definition (cont'd)

 Legislative process fundamental to movement
from a public problem to a viable program
 Societal problems that may qualify for a policy
solution are those brought to the attention of a
policymaker who is willing to take definitive
action through the policy process
Legislation and Health Policy
Development

 Analysis of issues for potential policy
development
 Public perception of the problem
 Definition of the problem
 Societal consequences and number of people
affected
 Degree of support and opposition from stakeholders
Legislation and Health Policy
Development (cont'd)

 Include introduction, committee action, House
and/or Senate action, and presidential action
 Very complex and convoluted process, with only
a fraction of legislation that is introduced actually
making it through the final process to become
law
Steps in the Legislative Process

 Once a bill becomes law, implementation falls
under jurisdiction of one of the departments of
the executive branch
 Implementation of new legislation often can be
very different from what was intended when the
bill was passed by Congress
Steps in the Legislative Process
(cont'd)

Health Policy
Regulation and Health Policy
Connection

 Regulation: written set of rules issued by the
government agency that has responsibility for
administering the new law
 Nurses can play an influential role by providing
input into the final regulations
Regulation and Health
Policy Connection

 Interval between interim rules and final rules
critical for assessing effect of the policy;
concerted nursing action is required
 Regulations carry the force of law
Regulation and Health
Policy Connection (cont'd)

Health Policy
Health Policy and Politics: Another
Key Connection

 Process by which the decisions of others are
influenced and control over situations and
events is exerted
 Influence is the common denominator in any
definition of politics
 Forms of political influence include money,
knowledge, relationships, information, talent,
and control over large groups of votes
Definition of Politics

 Politics is a necessary part of the policy process
when multiple interest groups compete to
achieve individual goals
 Politics also involves the varied agendas of the
Democratic, Republican, and Independent
parties
Politics and Policy

 Groups and individuals who have a stake in the
fate of a piece of legislation or the election of a
candidate use political strategies to attain their
desired outcomes
 Through effective political action, nurses can
positively influence legislative decisions and
health policies
Politics and Policy (cont'd)

 Nursing process is effective in identifying
broader professional and health care issues
Health Policy and the Nursing
Process

 Policy process and nursing process are
systematic approaches to address health care
and nursing laws
 Collection of information (assessment)—information
and data must be gathered from as many sources as
possible before the health care issues can be
identified
Process (cont'd)

 Identification of issues (diagnosis): information
analyzed to identify real issue or problem that
needs to be addressed
 Development of a plan: includes options and a
determination of professional consequences
with each
 Implementation of the plan: requires political
action and a set of strategies
 Evaluation of the intervention
Process (cont'd)

Health Policy
Grassroots Political Strategies

 Registering to vote and voting in all elections
 Joining a professional nursing organization
 Working in candidates’ campaigns
 Attending a “meet the candidates” town hall
meeting
 Visiting with policymakers or their staff
 Communicating with policymakers by e-mail, fax,
and phone
Grassroots Political Strategies

1. A proposed city ordinance is pending with the local
government that will require public buildings and
restaurants to be smoke and tobacco free. Which
action by the nurse should have the greatest
effect on passage of the bill?
A. Explain the rationale for the bill to your book club
and gain their support.
B. Contact the elected representative’s office by
phone to request support for the bill.
C. Support a health advocate to run for election as
city councilman.
D. Tell all fellow students about the bill.

2. When participating in grassroots political
strategies, the nurse should:
A. Refuse to vote in all elections until access to
health care is universal
B. Withdraw membership to professional nursing
organizations until the nurse/patient ratio is
reduced nationally
C. Educate candidates about the effects of the
nursing shortage on the quality of patient care
and patient safety
D. Avoid raising issues of economic uncertainty in
health care

Health Policy
American Nurses Association
(ANA)

 Professional nursing organization that
represents the nation’s 3.1 million RNs
 Composed of 51 constituent/state nurses’
associations that represent state and U.S.
territory nursing associations and includes many
organizational affiliates
Overview

 American Nurses Credentialing Center
 American Nurses Foundation
 American Academy of Nursing
 Specialty organizations such as the American
Association of Critical-Care Nurses
ANA Organizational Affiliates

 Medicare and Medicaid reform
 Patients’ rights
 Whistle-blower protection
 Access to health care
 Comprehensive health care reform
 Environmental and occupational health for
nurses
Examples of ANA’s Policy Issues

 Unifies nurses’ political voices across the
country to enact measures to enhance health
care for all
 Empowers nurses by encouraging them to take
action and make sure their opinions are heard
and understood by Congress and the public
 Provides structure and coordination for nurses
across the country to be involved in grassroots
lobbying
Nurses Strategic Action Team
(N-STAT)

Health Policy
Current Health Policy Issues

 General term used to refer to policy initiatives to
effect significant changes in how health care is
delivered and paid for
 Historic health care reform legislation has
become a reality with passage of The Patient
Protection and Affordable Care Act of 2010
 Provides for affordable and accessible health care
coverage for all Americans
Health Care Reform

 Access to care is the most significant problem to
address through health care reform
 Lack of insurance: greatest barrier to access to health
care
 50% of the uninsured have no regular source of
health care
 Uninsured more likely to delay or ignore needed
treatment
 Uninsured more likely to be hospitalized for avoidable
conditions
Health Care Reform (cont'd)

 Report calling attention to the essentiality of nursing in
reforming the health care system
 Four major recommendations:
 Nurses should practice to the full extent of their education and
training
 Nurses should achieve higher levels of education and training
through an improved education system that promotes seamless
academic progression
 Nurses should be full partners, with physicians and other health
care professionals, in redesigning health care in the United
States
 Effective workforce planning and policymaking require better
data collection and information infrastructure
The IOM Future of Nursing Report

Chapter 23

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Editor's Notes