The current healthcare system in the USA is viewed to be strikingly inefficient by the majority of experts, at least when compared to other healthcare systems around the world. The pay-for-fee model is considered to be inefficient, as it facilitates exorbitant price growth, which is then expected to be reined in and dealt with by the government. The USA is considered the top spender per capita when it comes to healthcare, standing at approximately 9500 dollars per capita. At the same time, the state of healthcare in the country remains to be improved on, as over 28 million people do not have any insurance coverage (Rosenbaum & Burke, 2011). This issue has been persisting even before the launch of the Affordable Care Act.
The current situation is the symptom of a larger problem. The system we have in place was built roughly 50 years ago, using the preconceptions, practices, and knowledge of that time. It was optimized for the paying capacity of the average American in 1970-1980 (Rosenbaum & Burke, 2011). The Affordable Care Act managed to expand healthcare coverage for many Americans that we’re unable to afford it, but at the same time imposed a great burden on the budget. Right now, the healthcare system in the USA is somewhere between a free-market system and a universal care system, with both parts molded together. It is not efficient.
In order to ensure the continuum of care (“Definition: Continuum of care,” n.d.), and provide affordable healthcare to the population, while at the same time retaining the core liberties and rights of medical workers to choose where they want to work and how much they wish to earn for their services. As it stands, the Affordable Care Act, while reimbursing healthcare providers from the federal budget, does little in the ways of changing the system. However, there are several projects that could provide the basis for large healthcare reform. One of these projects within the scope of ACA involves the creation of Accountable Care Organizations.
An Accountable Care Organization (ACO) is a group of healthcare providers that voluntarily form an organization to provide their patients with the highest quality of care available. ACOs can have different scopes and purposes and could range from nurse-managed health clinics to medical homes, community health centers, hospices, and retirement homes. This measure is aimed to decentralize healthcare and provide more access to the local communities. As it stands, all major healthcare practices are centralized around local hospitals.
This means that while healthcare coverage in the immediate areas around hospitals and healthcare centers gets excellent coverage, the further away a settlement or a community is, the worse the quality of healthcare becomes. By decentralizing the current healthcare system and spreading it across the countryside, it will be possible to ensure equality of coverage for all citizens and improve the quality and continuity of healthcare as a whole. In addition, it would enable nurses and doctors to choose between many different centers and organizations, effectively eliminating the regional monopoly of certain hospitals and provide competition that should, in theory, help decrease prices for health services and improve the overall quality of care. This paper will reflect on the opinions of nurses in regard to the incoming healthcare reform and provide important feedback for consideration and analysis in regards to the subject.
Nurse Opinion 1: The Reform will Cause Employment Crisis
The first nurse was of a very negative opinion about it. Her arguments against the reform were numerous, with varying degrees of validation to them. The most stressful and harmful part of the reform, according to her, was the employment crisis that she perceived would follow. As she said, currently, most hospitals experience a shortage of staff due to high burnout and turnover rates among nurses, and lack of programs to produce greater numbers of nurse graduates (Park & Shaw, 2013). She stated that with such a situation, the newly found ACOs would struggle to find personnel, as the demand for nurses would rise.
Underemployed ACOs will not be able to provide the superior quality of care that they claim to promote, and would instead cause an overall quality decline. Aside from that fact, she was worried that the reform would force relocation on many current hospital nurses. The ACO reform involves shortening a number of workplaces in acute care hospitals. While it is likely that high-ranking hospital staff would retain their positions, it is also likely that the nursing core will take a big hit, as many would lose their current jobs and would be forced to look for work in ACOs. These organizations would take some time to create, receive funding, acquire accreditation, tools, and instruments, and go through numerous formalities to establish a business.
In addition to that, forced relocation would break many professional relationships between nurses, which would cause a quality decline, as new teams would need to be formed, and nurses would learn to work with one another. Although the reform process looks promising on paper, the ACA looked promising as well, and none of the initial reviews prior to ACA’s implementation managed to predict the problems that the program faced soon after being launched. The nurse believes that prior to implementing this reform, the government should resolve the issue with nurse understaffing first and create a solid base for the creation of ACOs.
Nurse Opinion 2: ACOs will Improve Preventive and Home-Based Healthcare
The second nurse I interviewed during this project was much more positive and welcoming about the change than the previous one. She acknowledged the need for the communities to have healthcare centers in their immediate vicinity and stated that while centralized hospitals offer a simple supplying and logistical solution, they do not have the best interests of the communities in mind (Rosenbaum & Burke, 2011).
She also reflected on the fact that many nurses are reluctant to work in communities that are more rural and seek employment in big hospitals to live a city life, putting their own interests before the goal of promotion of health, or the patients in need of medical assistance. She views such self-serving behavior as irresponsible and contradictory to the holistic goals of medicine and thinks that with the appearance of ACOs in the area and lack of jobs in large acute care hospitals, nurses will be forced to migrate and settle in the communities. She also stated that this reform would be a welcomed change for those nurses who want to find work closer to home, but could not do so due to a lack of local employment.
Nurse Opinion 3: The Reform Does Not Tackle the Real Issues
The third nurse that I interviewed took a middle ground in regard to the reform. While she acknowledged the fact that it would help improve healthcare in the communities, she also pointed out that the main problem of the healthcare system in the USA is not the hospital expansion, but rather the overall costs for medical care. She stated that as long as the entire system remains in this transition stage between free-market and universal care, no system will alleviate the financial strain it causes on the patients and the government. Healthcare is not an industry that could be regulated with free-market means, as in many cases, the patient is not in the right physical, mental, and emotional state to bargain for a better price.
The fact that a third party, represented by numerous insurance companies, currently regulates our system eliminates direct contact between the provider and the recipient, which is yet another condition of the free market. Thus, the increase of competition between the newly found ACOs will not necessarily facilitate a decrease in prices, which is the core problem with our healthcare system right now (Blackstone & Fuhr, 2016). In the majority of American families, healthcare payments consume from 10 to 25% of the budget, even with the assistance provided in the scope of the ACA program (Blackstone & Fuhr, 2016). The nurse believes that healthcare should be made universal, due to the holistic and humanitarian nature of the practice itself, and that all restructuration reforms should take place after the elephant in the room – the exorbitant prices for even the simplest of medical procedures, have been removed.
As any medical reform that took place in the past three decades has to face a great deal of criticism. As it was represented in this paper, all three interviewees managed to highlight different potential problems with the ACO reform. While some focus on the problems with the implementation of the system, others state that the concept is outright wrong. Despite this, all three nurses acknowledged the fact that the ACO reform would help provide more available healthcare services to the communities and improve the reach of medical services towards the vulnerable population groups, particularly the elderly, and the groups with special healthcare needs.
Blackstone, E.A., & Fuhr, J.P. (2016). The economics of Medicare accountable care organizations. American Health and Drug Benefits, 9(1), 11-19.
Definition: Continuum of care. (n.d.)
Park, T.Y., & Shaw, J.D. (2013). Turnover rates and organizational performance: A meta-analysis. Journal of Applied Psychology, 98(2), 268-309.
Rosenbaum, S., & Burke, T. (2011). Accountable care organizations. Public Health Reports, 126(6), 875-878.