NUR 621 Economics and Quality

Sample Answer

The United States and its health care system face diverse health issues with significant effects on economics and quality of life as well as care. These issues include chronic diseases, obesity, healthcare disparities, suicide, and missed care.

The issues have significant effects on patients and their families, healthcare facilities, providers, and the healthcare system as well as the government at state and federal levels because of the associated economic burden and poor quality of life (Anders, 2021). Chronic diseases like hypertension and diabetes are critical health issues that affect American health system with the government spending over $4.1 trillion on costs related to their management.

The purpose of this paper is to discuss chronic diseases as a healthcare issue and its economic effects on the health care system and country’s economy, especially in regards to health care economics.

Significance of the Healthcare Issue to the U.S Chronic Disease.

In their article, Hayes and Gillian (2020) assert that the prevalence and cost of chronic disease are rising and will continue to grow not just due to the aging of the baby boomer generation but also because of increased disease prevalence among younger adults and children.

The article asserts that individuals with chronic disease and their families face both direct and indirect costs. The direct costs emanate from longer and more frequent hospital visits and increased use of prescription medication. Indirect costs emanate from lost opportunities in education and the job market.

The Centers for Disease Control and Prevention (CDC) asserts that chronic diseases and mental health conditions account for close to 90% of the nation’s healthcare spending or about $4.1 trillion every year. CDC also opines that chronic diseases are the leading causes of illness, disability, and death in the country. The agency also says that a majority of these diseases arise from a short list of risk factors that include poor nutrition, physical inactivity, and substance use like smoking and excessive alcohol use.

Chronic diseases are a significant healthcare issue in the United States because of the increased expenditure to manage and contain them. The CDC asserts that some groups are more affected by these diseases than others due to factors limiting their ability to make healthy decisions, especially on life promotion. The issue is significant since it accounts for 90% of the healthcare expenditure and close to 20% of the country’s gross domestic product.

In their study, Benavidez et al. (2024) observe that geographical regions and socioeconomic disadvantages also increase susceptibility to chronic diseases. According to the study, socioeconomically disadvantaged groups like those with lower household income, lower home value, lower levels of education attainment, and higher uninsured rates were susceptible to chronic conditions. Therefore, chronic diseases increase the cost burden not just for individuals and families but also for the healthcare system.

Impact of Health Care Economics on the Issue

At the core of health care economics focus on how cost-effectiveness considerations inform health care policies and resource allocation. Therefore, healthcare economics affects the lives of all Americans and encompasses critical challenging dilemmas society encounters today. Health economics examines ways of making health care more accessible, equitable, and affordable for the vast majority. Close to 14% of American workers or about 22 million individuals work in the health care sector.

Secondly, the U.S. spends about $4 trillion on health care, or 18% of its gross domestic product (GDP). It is estimated that the U.S. will spend close to 20% of its GDP on healthcare with chronic diseases getting close to 90% of this amount. Therefore, healthcare affects the economy with programs like Medicare and Medicaid Services requiring more resource allocation to make healthcare affordable, accessible, and of the highest quality.

In their article, Tikkanen and Abrams (2020) assert that the U.S. spends more on healthcare than all its peers in developed countries but with poor health outcomes. The article attributes the higher expenses on chronic diseases and investment in medical technology.

As such, healthcare economics impact the selected topic since the US spends a significant amount of its resources to ensure its citizens and residents get better, affordable, and appropriate health, especially aimed at reducing the prevalence of chronic diseases like diabetes, obesity, and hypertension among others.

Nurse Leader influencing the management of chronic disease

The prevalence of chronic disease continues to rise due to several factors, including an aging population and lifestyle as well as limited access to preventive primary care services. Nurse leaders have a critical role in helping federal and state governments manage the increasing burden of chronic disease.

Nurse leaders must encourage creativity, experimentation, and continuous learning among their subordinates aimed at increasing knowledge and focus on primary and preventive measures to reduce the prevalence of chronic diseases, especially among the staff. They should promote well-being among healthcare professionals and work in collaboration with other stakeholders to empower patients and the communities to embrace better strategies to remain healthy.

Nurse leaders improve access to evidence-based practice care interventions for individuals with chronic diseases. For instance, through increased education and training, nurse leaders empower nurses to provide patient information and effective strategies to reduce susceptibility to chronic disease.

Coordinated care allows nurse leaders to integrate the best approaches to help health populations, especially vulnerable populations, access quality and affordable care. Therefore, nurse leaders play a critical role in empowering nurses to enable patients to get the right education and integrate best practices in care to reduce the prevalence of chronic diseases.

Nurse leaders develop interventions and work with interdisciplinary teams to emphasize primary care in communities and reduce susceptibility to chronic diseases related to diet and nutrition and physical health and fitness.

Impact of Quality Measures on Reimbursement

Improving the quality of care is essential to eliminating and preventing the prevalence of chronic diseases among populations, especially those at increased risk like low-income individuals and households. Quality measures like value-based purchase models implore facilities and providers to focus on quality outcomes as opposed to the quantity of patients they serve.

The transition from volume to value means that facilities and providers can only get compensated for care offered when patients have better outcomes. The Centers for Medicare and Medicaid Services (CMS) reimburses providers for services offered based on the value to patients and not quantity.

For instance, Medicare’s Merit-based Incentive Payment System (MIPS) considers clinical outcomes, resource utilization, meaningful use, and clinical improvement activities to determine the final payment for facilities under its reimbursement system. Therefore, quality measures are a critical aspect of effective reimbursement as they demonstrate efforts by healthcare providers to improve quality outcomes.

In their study, Sarkar et al. (2020) the effects of quality of care in hospitals and their impact on pay-for-performance reimbursement. The article is categorical that facilities can only be compensated or reimbursed when they offer quality patient care. The implication is that quality measures determine the rate of reimbursement for healthcare facilities and providers.

Nurse leader’s Influence on Health Policy

Nurse leaders have a significant influence or impact on health policy because of their expertise, experience, and interactions with patients and the healthcare industry. As experts and leaders, nurses understand the health system and policies that lead to better outcomes for patients. Nurse leaders use their sphere of influence to shape policy within and outside their organizations.

For instance, nurse leaders can draft policies that integrate nursing staff on issues affecting care delivery within the organization. In their study, Inayat et al. (2023) explore ways to enhance nurse leader’s participation in policy-making. The authors note that appropriate strategies like having partnerships and empowering nurses help nurse leaders influence policies within and outside their organizations.

The article states that nurse leaders are instrumental in policy formulation and development since they are at the intersection between nursing staff and organization management.

Anders (2021) observes that nurses and nurse leaders are a critical part of health policy development and influence these policies by giving their suggestions, inputs, and perspectives based on their professional competencies, experience, and interactions with patients and other critical stakeholders in the healthcare sector.

Again, Hajizadeh et al. (2021) emphasize the role of nurses and nurse leaders in the policy-making process because of their expertise and understanding of the healthcare sector. Therefore, nurse leaders have a significant influence on health policy development and implementation.

Conclusion

Healthcare economics affect healthcare delivery as demonstrated by the analysis of the increasing prevalence of chronic diseases in the United States. Healthcare economics are essential to understand the significant resources from the national GDP dedicated to the health system to address issues like chronic diseases among Americans.

Nurses and nurse leaders play a critical role in the management of chronic conditions and policy development based on healthcare economics. Therefore, policies to improve primary care will help the United States reduce its burden of chronic diseases and their effects on its GDP.

References

• Anders, R. L. (2021). Engaging nurses in health policy in the era of COVID‐19. Nursing forum,
  56(1) 89-94. DOI 10.1111/nuf.12514
  
• Benavidez, G. A., Zahnd, W. E., Hung, P., Eberth, J.M. (2024). Chronic Disease Prevalence in the US Sociodemographic and Geographic Variations by Zip Code Tabulation Area. Preventing Chronic Diseases, 21 230267. DOI http //dx.doi.org/10.5888/pcd21.230267
  
• Centers for Disease Control and Prevention (CDC) (2024 May 15). About Chronic Diseases.
  https //www.cdc.gov/chronic-disease/about/index.html
  Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021).
  Factors influencing nurses participation in the health policy-making process a systematic review. BMC nursing, 20, 1-9. DOI https //doi.org/10.1186/s12912-021-00648-6
  
• Hayes, T. O. & Gillian, S. (2020 September 10). Chronic Disease in the United States A
  Worsening Health and Economic Crisis. https //www.americanactionforum.org/research/chronic-disease-in-the-united-states-a-worsening-health-and-economic-crisis/
  Inayat, S., Younas, A., Andleeb, S., Rasheed, S. P., & Ali, P. (2023). Enhancing nurses’ involvement in policy-making A qualitative study of nurse leaders. International nursing review, 70(3) 297-306. DOI 10.1111/inr.12828.
  
• Sarkar, R. R., Courtney, P. T., Bachand, K., Sheridan, P. E., Riviere, P. J., Guss, Z. D., … & Murphy, J. D. (2020). Quality of care at safety‐net hospitals and the impact on pay‐for‐performance reimbursement. Cancer, 126(20) 4584-4592. DOI 10.1002/cncr.33137.
  
• Tikkanen, R. & Abrams, M. K. (2020 January 30). The U.S. Health Care from a Global Perspective, 2019 Higher Spending, Worse Outcomes? The Commonwealth Fund. https //www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019