NSG 411 1st EditionFinal Exam Study GuideFinal Review All semester long we have been talking about advocacy as one of the PH interventions from the infamous Intervention Wheel. That’s what this week is about– how you as an RN can impact community health through policy and political action. #1 POLICY and HEALTH POLICYCH nurses are an important part of this process because they work where people are living their lives – schools, places of employment, homes, churches, clinics, etc. - What is a policy?-is defined as a plan of action or an agenda that outlines steps or actions to implement a stated goal or objective. Policies are laws, regulations or administrative rulings (when issued by national, state, or local govts. They are called public policy. - How is health policy different? Health policy refers to specific policies involving health care. - Distributive health policy: promotes non-governmental activities that are thought to be beneficial to society as a whole. Ex.) The Nurse Training Act, Title Vlll of the Public Health Service Act, which was established in 1965 and provided federal subsidies for nursing education in an effort to address the need for more nurses. - Redistributive health policy: changes the allocation of resources from one group to another, usually to a broader or different group. Ex.) Medicare, in that provisions under Medicare were expanded to provide a broader range of benefits and coverage to needy groups- such as those older than age 65 and the permanently disabled of any age - Regulatory health policy: is one that attempts to control the allocation of resources by directing those agencies or persons who offer resources orprovide public services. Ex.) certain government regulations set standards for the licensure of health care organizations (hospitals), and health care providers (nurses). Regulatory health policy is often used to protect the health of the community. In US we have mandatory reporting of certain communicable diseases. Broad scope including internationalcommunicable disease control, trade, human rights, armed conflict and arms control, and the environment. This policy can be divided into 2 subdivisions:-Competitive regulation: limits or structure the provision of health servicesby designating exactly who is permitted to deliver them -Protective regulations: set conditions under which various private activities can be undertaken.- Other types of policy: policy can also be viewed as the key interests of professional organizations, advocacy groups, work place policies, Now return to the beginning of the chapter…#2 CURRENT POLICY ISSUES- People who are uninsured or underinsured- 50.7 million people (16.7% of the population) were uninsured in 2009. This was the first year to show an actual drop in the number of people with health insurance tacking of these data first occurred in 1987. - Medical bankruptcy-a large scale study examined public records of bankruptcy filers, following up with questionnaires and telephone interviews and found that over 60% of bankruptcy filings were linked to medical expenses. 3/4ths of the medical debtors had health insurance, and most wereeducated middle class people. This is further proof that the underinsured, along with those individuals without health insurance are at risk of financial disaster when confronted with serious a serious medical emergency or long term illness. -our medical care system is the most expensive in the world, but our longevity is lower than in countries that spend much less than we do for health care while still providing care for their entire populations. - Workforce issues- the core functions of public health –assessment, assurance, and policy development became underfunded and underappreciated by local and state govt. There was a lot of nursing staff layoffs. The rate of public health nurses dropped from 219 to 158 per 100,000 people (2008). The pipeline for future nurses also diminished, as school of nursing have had to slash programs and reduce admissions due to budget problems. They have yet to recover the downsizing of nursing schools. The cyclical changes in health workforce patterns are accentuated by the graying of our workforce. RN’s above the age of 50 will soon become the largest age group within the profession. By 2025 a shortage of more than260,000 nurses is projected. Also the shortage of nursing faculty hinders nursing schools from accommodating students. - Economic influences-(some of this info is hard to decipher which is workforce or economic influences): the American association of colleges of nursing reported that “US nursing schools turned away 67,563 qualified applications from bachelors programs and graduate programs in 2010 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints. -health care costs increasing, insurance deductibles increasing#3 THE AFFORDABLE CARE ACT – this content is NOT from the text but ratherfrom the document for which a link was provided in your syllabus.Access to care – more options (4 main ways to get insurance: half of the people will get it from their jobs, 1/3rd will be covered by the govt. through medicare & Medicaid, 1 in 10 people will buy insurance themselves, still 130 million or so still will not have coverage at all. Employer-sponsored plans (caps on how much you have to pay out of pocket, free preventative care-bigger changes for those who are not insured that work for larger companies, govt. is going to require companies with 50 or more employees tocover full time workers or pay a penalty. Medicare – not much will changeMedicaid – if income is low (15,856 for a single person =poverty) – Medicaid will cover you (but it also depends on the state you live in). and the Children’s Health Insurance Program Affordable private plans – health affordable market places. Private insurerscompeting for you. You can pick how much coverage you want and how muchyou have to pay for it. (most all will include the basics of: hospital visits, doctors visits, maternity care, mental health care, and prescription drugs) Health care delivery system reforms for health promotion/disease prevention1. Annual wellness visit2. Additions to new health insurance policies3. Different models for care deliverySupport for nursing education#4 FOUNDATIONS OF ADVOCACY: the basic concepts of public health have evolved over the last 150yrs. From an emphasis