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Health Policy and Delivery Systems

Health Policy and Delivery Systems

Health Care Legislature – “Lower Health Care Costs Act of 2019: Better patient access”

The healthcare industry has undergone significant changes over the years. The healthcare industry is now regarded as one of the most important in the country. As a result, healthcare legislation is a vast industry. There have been difficulties in recent years, such as enhanced patient access, increased payer transparency, and single-payer systems (Gaffney et al., 2019). Healthcare has swiftly become one of the most pressing topics in the country. In recent years, healthcare policymakers have expressed concern about the industry’s healthcare difficulties (Aulakh, 2019). The purpose of this literature is to provide information about the 2019 Lower Healthcare Cost Act to improve patient access.

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Many agencies, including the Senate Health, Education, Labor, and Pension Committee, introduced the Reduce Health Care Costs Act of 2019 in June 2019. It should be noted that this Act is a proposal designed to enhance the efficient interchange of health information while also improving the security and privacy of health data. Furthermore, it was implemented to cut healthcare expenditures for patients. Section 501 of this Act requires patients filing health claims to receive network and cost information that will assist them in making better insurance decisions (Aulakh, 2019). Senators incorporated these conditions based on previous difficulties concerning the challenges of improved patient access. According to this draft measure, the senate members established the purpose: “to assist patients in picking the most effective health insurance plan for their family, which will be followed by navigating that specific plan when they need care. This goal ensures that patients have complete, computerized access to their health information, as well as information based on what they would pay for specific care.”

This policy is crucial for doctors and other healthcare providers. It is important to stress that the burden will likely fall on payers rather than providers. According to the Act, this new policy would force payers to submit consumer health insurance claims data, a list of in-network practitioners, and out-of-pocket costs (Aulakh, 2019). Patients will have better access to their healthcare data if this Act passes in the Senate, allowing them to make better choices and decisions about their care. Nonetheless, it is crucial to note that passing this Act will almost certainly necessitate some adjustments to physicians’ EHR systems to increase patient accessibility.

Another purpose of this Act is to set a standard for health insurer-provider payment disputes, to prohibit out-of-network deductibles during emergencies, and to limit consumers’ out-of-pocket payments for air ambulance transportation. It should be noted that insurance companies will be compelled to repay or refund providers based on the local median contracted commercial amount agreed to pay other contracted providers. This should occur in a geographical area established by the US Department of Health and Human Services (Khullar & Chokshi, 2018). Despite this, the federal government is lagging behind state legislators nationwide in the fight against surprise medical billing. In Texas, for example, the current governor signed legislation to safeguard patients from unexpected medical expenses when a disagreement between the insurance company and the patient’s medical provider is encountering difficulties.

Florida, California, Oregon, Illinois, New York, New Hampshire, Connecticut, New Jersey, and Maryland are among the states having extensive surprise charging assurance legislation. These laws apply to HMOs, PPOs, crisis offices, and non-crisis medical clinic administrations. They protect patients from financial risk, determine how much cash guarantors must compensate suppliers, and establish a contest target measure. Arizona, Colorado, New Mexico, Texas, Minnesota, Iowa, Indiana, Mississippi, Pennsylvania, West Virginia, North Carolina, Vermont, Maine, Massachusetts, Rhode Island, and Delaware are among the states having fractional amazement pricing insurance regulations.

This Act is crucial in the healthcare sector because it will not only strengthen legislation protecting patients from unexpected medical bills, but also play an essential role in creating fair compensation standards for healthcare providers and increasing payer transparency. Physicians, particularly those in emergency treatment, must be conversant with the intricacies of this Act.

The Nurse’s Role in Legislation

Nurses play a role in health law. It is vital to highlight that nurses are active in patient advocacy daily. There are various professional groups where nurses can actively engage in the passage of healthcare legislation or examine policies. It should be noted that professional organizations such as the American Nurses Association (ANA), the Emergency Nurses Association (ENA), and the American Academy of Nursing (AAN) play a significant role in assisting nurses in actively participating in the passage of health legislation (Newman & Kjervik, 2016). It is vital to highlight that these professional health organizations were formed to ensure that any policy is successful and safeguards the interests of patients and health care providers.

The workplace is the second method a nurse might be active in the passage of laws. According to Newman and Kjervik (2016), nurses are professionals with the obligation and ability to affect present and prospective healthcare delivery systems. The primary purpose of nurses in the healthcare sector is to promote quality health, and nurses are more likely to influence policy reviews through their workplace by ensuring that the policies pushed are effective in their workplaces.

To summarize, the healthcare business has undergone considerable transformation throughout the years to promote excellent healthcare delivery to the public. In June 2019, some healthcare stakeholders, including the Senate, passed legislation to reduce healthcare costs. The measure is the “Lower Health Care Costs Act of 2019.” This Act is a proposal to enhance the efficient exchange of health information while improving health data’s security and privacy. Furthermore, it was implemented to cut healthcare expenditures for patients.

Other Related Post: Patient Experience Measurement Program in Saudi Arabia.

References

Aulakh, R. (2019). Understanding Diversity in Health Care for a Better Doctor-Patient Relationship. Acta Scientific Paediatrics, 2(11), 01–01. doi 10.31080/aspe.2019.02.0175

Gaffney, A., M.D., McCormick, D., M.D., Bor, D., M.D., Woolhandler, S., M.D., & Himmelstein, D., M.D. (2019). Coverage expansions and utilization of physician care: Evidence from the 2014 affordable care act and 1966 Medicare/Medicaid expansions. American Journal of Public Health, 109(12), 1694-1701. doi:http://dx.doi.org/10.2105/AJPH.2019.305330

Khullar, D., & Chokshi, D. (2018). Can Better Care Coordination Lower Health Care Costs? JAMA Network Open, 1(7), e184295. doi: 10.1001/jamanetworkopen.2018.4295

Newman, A., & Kjervik, D. (2016). Critical Care Nurses’ Knowledge of Confidentiality Legislation. American Journal Of Critical Care, 25(3), 222–227. doi: 10.4037/ajcc2016518

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Question 


Discussion: Think about a familiar clinical practice area where interest groups are attempting to bring about a change in clinical care or systems of service delivery. Assume new, game-changing research findings are published and receive wide attention. Identify groups that might have an interest in these findings. What are their likely reactions to further research?

Health Policy and Delivery Systems

Health Policy and Delivery Systems

Requirements:

– Formatted and cited in current APA 7

– The discussion must address the topic

– Rationale must be provided

– Use at least 600 words (no included 1st page or references in the 600 words)

– Use three academic sources. Not older than five years

– Not Websites are allowed.

– Plagiarism is NOT allowed

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