Nursing's Proposal for Health Care Reform
Joel, Lucille A. EdD, Rn, Faan, Scholarly Inquiry for Nursing Practice
Equitable access to health care is a fundamental belief of nursing. Reform of America's health care system to provide access to essential services will require restructuring the delivery arrangement for services. The triad of access, quality, and cost is among the fundamental reforms that America's nurses envision.
Heroics and sophisticated technology save lives. But by failing to provide universal access to essential primary health care, preventable illnesses flourish and chronic diseases become a way of life.
Unequal access cannot be reconciled with desired emphasis on prevention and early intervention. Nurses recognize that reforms must be viewed within a larger social, economic and political context. Poverty, exposure to illicit drugs, inadequate nutrition, and poor education individually and collectively contribute to poor health. Unacceptable infant mortality rates, increasing teen suicide rates, chronic substance abuse problems, and the spread of preventable diseases, including measles, tuberculosis and HIV, fuel the skyrocketing costs of health care.
In 1990, the national health bill was 12.4% of the Gross National Product. Analysts expect that amount to rise 12% to 15% a year. At that rate, it would reach nearly $1.8 trillion in 1995 and nearly $2.7 trillion by the year 2000 (Bowsher, 1991). In 1989, health care benefits cost companies $2,700 per employee. In 1990 this figure exceeded $3,000 (Health Insurance Association of America, 1990). There are 34 million people uninsured and of this number 20 million are employees and dependents who work for small businesses (Meyer, Sullivan, & Silow-Carroll, 1991).
As these problems push health care and insurance costs higher, more organized groups are getting involved in the health care reform movement. Each group has its own agenda, although recently business has joined providers, consumers, insurance companies, and legislators as participants in the debate over resolving the problems that plague America's health care system (Miller, 1991). Among its other positions, business has voiced concern about the access and quality of services, most notably as they affect pregnant women and their children?America's future workers and employees (National Leadership Coalition for Health Care Reform, 1991).
Nursing is in a position to define the factors that create the system's problems and to identify the most efficacious resolutions to those problems. The result of the profession's unique insight and expertise isNursing's Agenda for Health Car Reform (American Nurses Association, 1991), apian that is realistic, practical and based on first-hand understanding of what needs to be done. The Agenda presents a comprehensive health policy plan that addresses access, quality of care, financing, and implementation. It is a bold new vision for reform?one that keeps what works best in our current system but casts aside institutions and policies that fail to meet present and future needs. It calls for no new dollars, but for the reallocation of existing dollars.
Nursing's agenda calls for universal access to a federally defined package basic health benefits. Access would be guaranteed through a new delivery structure that would emphasize managed care and care delivered in convenient, familiar, community-based sites such as schools and the workplace. Consumers would be encouraged to take more responsibility for their own health, with health care providers educating them about healthful behaviors. …