political pressure

Assignment 1 +DB 4

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Although there is often political pressure to create programs that increase access to services, these programs often are unfunded mandates. The expansion of insurance

coverage is directly linked to health care costs, and controlling these costs presents a tremendous challenge. This week’s readings present information on cost

evaluation; potential trade-offs related to cost, quality, and access; and financial and economic principles that apply to cost evaluation in delivering health care


An example of the difficulty of addressing these competing interests can be seen in a case study concerning “The Impact of the Affordable Care Act on North Carolina’s

Uninsured Population”. This Assignment focuses on ethical, financial, and quality of care aspects surrounding the issue.

To prepare:
•Read the case study about “The Impact of the Affordable Care Act on
North Carolina’s Uninsured Population” on pages 202–203 in Health
policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.).
•Reflect on what you have learned from the readings and media segments about health care financing as you read the case study.

To complete this Assignment, write a 3- to 5-page paper that addresses the following:
•Explain the impact of the Affordable Care act on the population that it affected.
•Explain the impact of the economics of providing care to patients from the organization’s point of view.
•How will patients be affected in relationship to cost of treatment, quality of treatment, and access to treatment?
•What are the ethical implications of this act for both the organization and the patients?

•Kovner, A. R., & Knickman, J. R. (Eds.). (2011). Health care delivery in the United States (Laureate Education, Inc., custom ed.). New York, NY: Springer Publishing.

?Chapter 3, “Health Care Financing” (pp. 47–66)

This chapter attempts to unravel several of the complexities in America’s health care system, and it also provides an analysis of the health care/insurer/patient

relationship and how hospitals are actually funded.
?Chapter 12, “Health Care Costs and Value” (pp. 257–276)

Rising costs of health care and potential approaches to constraining growth in health care expenditures are examined in this chapter.
?Chapter 15, “Health Workforce” (pp. 315–329)

This chapter looks at the nature of the supply and demand for health care professionals in the United States.

•Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers. ?Chapter 10,

“Overview: The Economics and Finance of Health Care” (pp. 191–206)

This chapter breaks down the basic elements of economics as they relate to health care, explaining how consumer choice combined with limitations on what hospitals can

supply affects the type of care given.

•Reinhardt, U. E. (2010, Jan 20). State of the nation (a special report): Voices—A good start. The Wall Street Journal, p. R5.
Retrieved from the Walden Library databases.

This article describes how the U.S. health care reform bill seeks to obtain better value for the U.S. health care dollar by generating more research into cost-

effective care.
•Stein, R. (2010, November 8). Review of prostate cancer drugs Provenge renews medical cost-benefit debate. The Washington Post. Retrieved from


This article describes a federal review conducted to determine whether Medicare expenditures should be allocated to an expensive prostate cancer vaccine. The author

details both sides of the debate on the issue.


•Laureate Education, Inc. (Executive Producer). (2012c). Healthcare economics and financing. Baltimore, MD: Author.

Note: The approximate length of this media piece is 16 minutes.

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Optional Resources

The following resources may support the Assignment; however, they are not required readings.
•Müller, D., Zimmering, M., Chan, C., McFarlane, P., Pierratos, A., & Querfeld, U. (2008). Intensified hemodialysis regimens: Neglected treatment options for children

and adolescents. Pediatric Nephrology, 23(10), 1729–1736.
Retrieved from the Walden Library databases.
•Neil, N., Walker, D. R., Sesso, R., Blackburn, J., Tschosik, E. A., Sciaraffia, V., & … Bhattacharyya, S. K. (2009). Gaining efficiencies: Resources and demand for

dialysis around the globe. Value in Health, 12(1), 73–79.
Retrieved from the Walden Library databases


Did you know that the United States has a higher rate of infant mortality than Japan (CIA, n.d.)? Or, as Dr. Beilenson states in this week’s media presentation, that

“your zip code that you live in makes more difference in your health and well-being than the genetic code that you’re born with?” What causes these differences in

health outcomes?

To effectively develop policies and programs to improve population health, it is useful to use a framework to guide the process. Different organizations and

governmental agencies (for example, Healthy People 2020) have created a variety of such frameworks, which establish measures for assessing population health. These

measures frequently are derived from the examination of epidemiologic data, which include key measures of population health such as mortality, morbidity, life

expectancy, etc. Within each measure are a variety of progress indicators that use epidemiologic data to assess improvement or change.

For this Discussion, you will apply a framework developed by Kindig, Asada, and Booske (2008) to a population health issue of interest to you. This framework includes

five key health determinants that should be considered when developing policies and programs to improve population health: access to health care, individual behavior,

social environment, physical environment, and genetics.

To prepare:
•Review the article “A Population Health Framework for Setting National and State Health Goals,” focusing on population health determinants.
•Review the information in the blog post “What Is Population Health?”
•With this information in mind, elect a population health issue that is of interest to you.
•Using this week’s Learning Resources, the Walden Library, and other relevant resources, conduct a search to locate current data on your population health issue.
•Consider how epidemiologic data has been used to design population health measures and policy initiatives in addressing this issue.

Post by Day 3 a summary of how the five population health determinants (access to health care, individual behavior, social environment, physical environment, and

genetics) affect your selected health issue, and which determinants you think are most impactful for that particular issue and why. Explain how epidemiologic data

supports the significance of your issue, and explain how this data has been used in designing population health measures and policy initiatives.
Education, Inc., custom ed.). New York, NY: Springer Publishing. ?Chapter 5, “Population Health” (pp. 85–102)

This chapter introduces the concept of population health, which views health issues at the population level rather than at an individual level.

•Kindig, D. (2007). Understanding population health terminology. The Milbank Quarterly, 85(1), 139–161.
Retrieved from the Walden Library databases.

This article provides a valuable foundation in understanding the terminology of population health. Although written in 2007, the information in this article is very

pertinent to the topics discussed this week.
•Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083.
Retrieved from the Walden Library databases.

Using a framework to craft policy and programs can help ensure that outcomes are measurable. The authors of this article note how some of the overarching goals of

Healthy People 2010 were not measurable. They suggest a framework for developing more measurable goals for Healthy People 2020.
•Centers for Disease Control and Prevention. (2010). Morbidity and mortality weekly report (MMWR). State health statistics. Retrieved from


The CDC website provides health statistics gathered using epidemiologic methods. Explore the health statistics for your state or for a health problem of interest to

•HealthyPeople.gov. (2010). Foundation health measures. Retrieved from http://healthypeople.gov/2020/about/tracking.aspx

Healthy People 2020 uses the four foundational measures presented at this website to monitor the health of the American population.

•State of New South Wales, Department of Education and Communities and Charles Sturt University. (2012). Core 1: Health priorities in Australia: How are priority

issues for Australia’s health identified? Retrieved from http://hsc.csu.edu.au/pdhpe/core1/focus/focus1_1/4003/health_pri1_1_1.htm

Australia uses epidemiologic data to establish its health priorities. Review the information presented at this website, and consider how the United States sets its

health priorities.
•U.S. Department of Health and Human Services. (2010). Healthy People 2020. Retrieved from


This overview of Healthy People 2020 provides a description of goals of this program, along with indicators used to assess the health of the United States.
•U.S. Department of Health and Human Services. (2012). Healthy People 2020 – Improving the health of Americans. Retrieved from


This site contains a wide variety of information and resources dealing with the Healthy People 2020 goals, as well as information on how to implement the objectives.
•University of Wisconsin Department of Population Health Sciences. (n.d.). What is population health? Retrieved from


This website provides a definition of population health and health determinants. It also examines how health policy can influence determinants of health.


•Laureate Education, Inc. (Executive Producer). (2012h). Population health. Baltimore, MD: Author.

Note: The approximate length of this media piece is 13 minutes.


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