Page 265 - Essentials of Nursing Leadership and Management, 5th Edition

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252 unit 3 | Professional Issues CikguOnline
(NIH). Originally a center at NIH, it became a As managed care plans grow and spread across
full-fledged insititute in 1993. NINR supports and the country, these companies become powerful
conducts basic and clinical research and provides enough to be able to negotiate reduced rates (dis-
research training in health promotion, disease and counts) from local hospitals (Trinh & O’Connor,
disability prevention, quality of life, health dispari- 2002). They can, in effect, say, “We can get an
ties, management of symptoms, and end-of-life appendectomy for $2300 at hospital A; why should
care encompassing the entire life span (http://www. we pay you $2700?” If hospital B does not agree,
ninr.nih.gov). the hospital may lose all the patients enrolled
in that managed care plan.This pressures hospital B
Specialty Organizations to reduce costs and spread staff even thinner than
before.
In addition to the national nursing organizations, Similar price pressures come from Medicare,
nurses may join specialty practice organizations Medicaid, and other health insurance companies.To
focused on practice areas (e.g., critical care, neuro- keep costs under control, some states have cut bene-
science, obstetrics) or special interest groups (e.g., fits for people receiving Medicaid (state-supported
male nurses, Hispanic, Philippine, Aboriginal health benefits for low-income people) (Pear, 2002).
nurses). These organizations provide nurses with With the upsurge in for-profit health plans and
information regarding evidence-based practice, the purchase of not-for-profit hospitals by for-
trends in the field, and approved standards of spe- profit companies, U.S. health care has become
cialty practice. Links to nursing organizations may increasingly “corporatized.”It was thought that this
be found at nursingsociety.org/career/nursing_orgs. would yield a highly efficient, responsive system
html or http://www.cna-nurses.ca (“the customer is always right”). That has not hap-
pened because the “customer” who pays for insur-
Health Care Today ance coverage is actually the employer or the gov-
ernment, not the individual patient. The care
Among the industrialized countries of the world, provided by the for-profits, in general, appears to
the United States is the only one that does not pro- be of lesser quality than the old not-for-profit or
vide basic health-care coverage to every citizen fee-for-service plans (Mechanic, 2002).
(Lieberman, 2003). Forty-seven million Americans There is a limit to the extent to which cost cut-
have no health insurance (ANA, 2008a), yet the ting can increase efficiency without endangering
United States has technologically advanced, highly patients. A series of important research studies has
sophisticated health care and spends more per shown that increasing the number of RNs provid-
capita (per person) than most countries. ing care in a hospital has a direct effect on improv-
If the United States has the most advanced ing the outcomes of patient care.
knowledge and equipment and spends a great For many years, the United States has been try-
deal of money on health care, then why the cause ing to fix its health-care system by applying patch-
for alarm? What is wrong? Why doesn’t everyone es over its worst cracks, but this has apparently not
have health-care insurance? Why are people so worked very well. Does the system need a major
worried about the quality of care? The answer is overhaul? Yes. But first, there needs to be a clear
complex. vision of what it should be and what it should do
For most people, health insurance comes (O’Connor, 2002).Whatever way that vision devel-
through their place of employment. One problem ops, it is certain that nurses will have an important
with this is that many employers are motivated to role in a future health-care system. As Aiken and
keep the cost as low as possible or transfer much of colleagues (2002) wrote, “nurses contribute impor-
the cost to the employee. Another problem is that tantly to surveillance, early detection and timely
if one loses one’s job, health insurance is also lost. interventions that save lives” (p. 18).
Managed care was originally designed to reduce The ANA, among others, has described the cur-
the amount spent on health care by emphasizing rent health-care system in the United States as
prevention. Some have said that it has become a “sick”and “broken”(ANA,2008a).As stated before,
way to limit choices and ration care (Mechanic, forty-seven million Americans, including 9 million
2002) rather than prevent illness. children, have no health-care insurance. Even