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NHS FPX 6008 Assessment 3 Business Case for Change

Student Name

Capella University

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Slide 1:

Hello everyone, this is megan. I would like to thank you for your presence and patience. My topic of presentation is the business case for change. 

Slide 2: 

Introduction 

Healthcare in the US is largely dependent on insurance companies, and with the rising prices of medication and healthcare, maintaining the quality of care out of one’s pocket has become one of the most challenging tasks. Therefore, insurance companies play a significant role in ensuring the quality of care. The high cost of healthcare has become a burden on U.S. families, and the cost of healthcare has contributed largely to decisions about insurance coverage and care provision (Kearney et al., 2022).

However, the cost of the insurance also causes financial worry, as either the installment is too much or the care provided is inadequate. Surveys have highlighted that around 43% of working adults had inadequate insurance in 2022, while 9% were uninsured and had a gap in coverage over the past year up to 11%, or either were underinsured, meaning that their coverage didn’t provide them with access to care (23%) (The Commonwealth Fund, 2022).

Slide 3: 

Impact on healthcare:

The insurance issue is one of the most significant issues impacting the healthcare system, as we all know that insurance is one of the most frequently used ways to manage the cost of healthcare expenses. Therefore, its impact on my work as a nurse, my colleagues, the organization, and the overall community is interlinked and complex. 

First of all, it impacts our work as nurses and healthcare providers, as insurance issues directly impact the work of nurses, doctors. The nurses respond to changes in the regulation and financing of healthcare with innovation and responsibility. Thus, my job is to help the client get healthcare within the limits of the insurance while influencing how it is viewed. The constant struggle of making the reading policies provide interventions within the limits of their standards of care as most time is invested in navigating the insurance policies and providing the quality of care with constrained resources and options that the insurance covers (Rudman, et al.,2020). Also, it leads to occupational stress and burnout from providing care when I have to refuse patients their right to care due to financial constraints.

When the insurance doesn’t cover the patient’s full care, the organization or the patient must pay for it, which can put a strain on the organization’s finances. sources that could affect the company’s care (Laprise, 2023).  The organization struggles with insurance companies’ reimbursement rates and policies that don’t match its reimbursement rate, which affects its financial stability. This low insurance company reimbursement rate may cause economic difficulties and layoffs (Turale, & Kunaviktikul, 2019). When a health care issue occurs in society or the healthcare sector, it endures in the community, like how insurance coverage influences access to care. Due to insurance companies inability to cover their medical expenditures, older people often decline healthcare facilities.

Slide 4: 

Feasibility and Cost- Benefit Considerations

The feasibility refers to the practicality and viability of implementing the insurance plan, which includes several factors such as healthcare insurance size and the nature of the organization, financial resources, insurance coverage details, and the requirement for the regulation of insurance. However, the cost and benefit analysis provides a unique yet practical picture of healthcare insurance. It involves comparing the cost and benefits of the insurance, such as the deductibles, payment methods, administration expenses, and insurance coverage. While the benefit includes the medical service plan, medication, preventive care, and financial protections. The selection of the insurance is strictly based on the weight the benefits have against the costs.

Slide 5 

Ways to mitigate

  1. Risk management is an important aspect of the implementation of insurance to mitigate the potential risk to financial security for the organization. Risk management allows the organization to identify and assess multiple risks, such as changes in the regulatory processes, changes in the market dynamics, and unexpected medical causes. Along with that, it helps in managing the insurance available and the coverage policies to ensure that the organization has insurance coverage. Similarly, it helps protect the patient from the potential risk of having a certain amount of insurance and allows doctors to investigate the coverage of the insurance and the treatment process according to their insurance coverage.
  2. Another way to meet the financial security risk of the organization is to evaluate the insurance available, the coverage policy, and the insurance company that is serving the organization and the patients as well. By identifying the financial security drift and insurance coverage policy, the organization can make plans accordingly and work in a way that can secure organization funds while also providing quality care to the patients. Also, by carefully monitoring and utilizing the Medical services, organizations can easily identify overutilization or underutilization of the procedures and thereby easily reduce expenses.
  3. Lastly, health promotion and disease prevention initiatives allow the organization to develop a better picture of itself. When organizations invest in health promotion and disease prevention initiatives, this subsequently reduces the overall Healthcare cost and improves the financial security of the organization. So by focusing on preventive measures and promoting the organization, the organization can reduce the cost of medical expenses and interventions and can focus on creating vaccination health education campaigns and Wellness programs that allow the patients to be better and reduce the overall cost of healthcare.

Slide 6

Implementation Plan  

  1. Financial security improvement The first implementation plan strategy is to develop comprehensive financial security improvement plans that can provide nurses as well as patients with better financial security by reducing out-of-pocket expenses and ensuring that insurance coverage is wide-ranging for all of the health care services.
  2. Increase Access to Healthcare. One of the major issues in the insurance gap is that people don’t have access to care due to the financial value of seeking preventive care, early intervention, and necessary treatment, which is difficult. Access to care can help provide preventive and early intervention along with necessary treatment without fearing financial barriers.
  3. Universal Health Care It is important to ensure that all people have similar insurance policies or standardized public insurance. All people have the same rights as us in the health care system and facilities in order to reduce economic and social injustice and make people feel a part of the healthcare system regardless of their financial background.
  4. Government policies. In order to bring about change in the healthcare system, it is important to implement policies that are universal throughout the country and ensure that every healthcare apartment and institution follows the same government policies or guidelines to help people with their insurance and insurance-related queries.
  5. Community health improvement With an improved insurance coverage facility, it is impossible for the patients to have better health and wellbeing because of the care they are receiving. Improving the overall community’s health can introduce various health care access options for the patients as well as for the professionals to provide better help facilities based on the insurance facilities.

Slide 7

Cultural Sensitivity and Ethical Equitability

When it comes to insurance issues, there are many social, economic, and diverse perspectives on how insurance impacts people or particular groups or populations. These issues have made it clear that not everyone receives health care and that, in some areas, insurance has led to an economic gap between people, as a result of which some people have better access to the healthcare system than others. It also explains the difference between population growth and the experience of receiving health care, and the factors that may have influenced these differences are social differences (Sohn, 2016).

Economic differences, ethnicity, and racial differences also contribute to creating that dispersion among people, such as poor people who have low income (Stansbury, 2022). People experience insurance issues because, in comparison to those with higher incomes, their insurance is either very limited or nonexistent. Their approach to health care would be completely different from that of those who have better income resources and can gain better coverage deals from insurance companies. Also, it could become a significant barrier to accessing healthcare services and may have led to poor healthcare outcomes. 

Slide 8 

Continued from previous slide

Unfortunately, this economic gap in America has created a very different situation for the people because they receive care that causes harm to them or they do not receive care at all. The care that is being provided to people is either too late or not with full consideration of the patients’ preferences and values because their insurance does not equate with their preferences or values for the care that the day demands. This creates an environment of providing care either to the less fortunate or unjustly. 

A  systematic review highlighted that public health insurance in low or middle-income countries has a significant impact on improving healthcare provision to patients and the utilization of healthcare facilities (Erlangga et al., 2019).

Also, another study has shown that people who experience gaps in their health insurance coverage are less likely to have regular sources of care and may have delayed or missed appointments, while adults who lack insurance for a whole year have poor access to care and have more health issues (Garfield et al., 2019).

Slide 9 

Conclusion 

To conclude my presentation, The conjuring increase in the prices of health care services and the availability of almost negligible insurance make it very difficult for people to access Healthcare and have better treatment options because their insurance is not paying enough for their medical expenses or they don’t have any. similarly to the work of health care professionals such as nurses, doctors, organizations, and the whole community.

As for the nurses, it impacts their ability to completely focus on providing care, and rather the focus is divided between finding appropriate policies and treatment options for the patient within their insurance category and teaching the patient regarding their insurance and its coverage. To pay for the full expenses significantly impacts the financial security of the organization, and does this inability affect one’s ability to reach out for the health care services of a time when people refuse to take medical care just because they are unable to just cover their expenses?

An approach is required to deal with the issues through strategies such as improving that come over all community health care, providing a universal health care system, and implementing government policies that allow for a uniform insurance across the country and to provide leverage to the organizations that are providing health care services to the people. And to reduce the financial burden on the individual while increasing the financial security of the organization and the patient as well. Lastly, many of the insurance issues are deep in the cultural and ethical dispersion of the community; therefore, it is important to understand the cultural and ethical diversity and mitigate those differences.

Thank you very much. If any of you have any questions, you are free to ask.

Slide 10 

References 

Erlangga, D., Suhrcke, M., Ali, S., & Bloor, K. (2019). The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review. PLOS ONE, 14(8), e0219731. https://doi.org/10.1371/journal.pone.0219731

Garfield, R., Orgera, K., & Damico, A. (2019, May 13). The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act – How does lack of insurance affect access to care? The Henry J. Kaiser Family Foundation. https://www.kff.org/report-section/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act-how-does-lack-of-insurance-affect-access-to-care/

Kearney, A., Hamel, L., Brodie, M., & Montero, A. (2022, July 14). Americans’ challenges with health care costs. Kaiser Family Foundation; KFF. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

NHS FPX 6008 Assessment 3 Business Case for Change

The Commonwealth Fund. (2022, September 29). The State of U.S. Health Insurance in 2022. Www.commonwealthfund.org. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey#:~:text=Forty%2Dthree%20percent%20of%20working

Laprise, C. (2023). It’s time to take a sustainable approach to health care in the face of the challenges of the 21st century. One Health, 100510. https://doi.org/10.1016/j.onehlt.2023.100510

Turale, S., & Kunaviktikul, W. (2019). The Contribution of Nurses to Health Policy and Advocacy Requires Leaders to Provide Training and Mentorship. International Nursing Review, 66(3), 302–304. https://doi.org/10.1111/inr.12550 

Rudman, A., Arborelius, L., Dahlgren, A., Finnes, A., & Gustavsson, P. (2020). Consequences of early career nurse burnout: a prospective long-term follow-up on cognitive functions, depressive symptoms, and insomnia. EClinicalMedicine, 27, 100565. https://doi.org/10.1016/j.eclinm.2020.100565

Sohn, H. (2016). Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course. Population Research and Policy Review, 36(2), 181–201. https://doi.org/10.1007/s11113-016-9416-y

Stansbury, A. (2022, June 10). Economics Needs More Socioeconomic Diversity. Harvard Business Review. https://hbr.org/2022/06/economics-needs-more-socioeconomic-diversity

NHS FPX 6008 Assessment 3 Business Case for Change