S.1903 – Reducing Disparities Using Care Models and Education Act of 2015
Abstract
This paper discusses the bill focused on the reduction of health disparities faced by the US population and its influence on APN practice. It is determined that the environment that made the legislators discuss this issue included sociocultural, ethical, economic, political, and legislative problems faced by deprived populations. Two main sponsors of the bill and its stakeholders (both consumers and providers) were involved in its progression. As a result, guidelines for the reduction of disparities were developed, which improved access to healthcare services, but they were not accepted by all medical professionals. The bill might have been improved if it included a clear identification of the population in need and its major health problem.
Bill # and Title
The bill S.1903 – Reducing Disparities Using Care Models and Education Act of 2015 was introduced in the Senate two years ago. It was sponsored by Senator Cory A. Booker who represented Democratic Party from New Jersey. The bill was “referred to the Committee on Health, Education, Labor, and Pensions” (Library of Congress, 2016, para. 1). Initially, it urged the Department of Health and Human Services to make the Institute of Medicine focus on one of the most critical healthcare issues faced by the world’s population. In particular, attention was paid to health disparities. According to the bill, it was important to focus on the existing programs and policies that were associated with this problem and to assess their effectiveness. In this way, it was vital to identify their drawbacks and advantages. Moreover, knowing those disparities they were targeting and peculiarities of the interventions, professionals can receive an opportunity to develop the following plan of action.
Healthcare Issue
The bill requires the Department of Health and Human Services to prepare guidelines that can be used by entities. They should receive an opportunity to implement those initiatives that will reduce health disparities among the population of the USA. Moreover, the Department of Health and Human Services is encouraged to provide grants for some of these programs so that financial obstacles can be minimalized. In addition to everything mentioned above, the bill approaches the Innovation Center of the Centers for Medicare & Medicaid Services. It discusses the necessity to test a new payment and service delivery model that can be used to reach this purpose.
Centers for Disease Control and Prevention support the bill, as they also identify health disparities as one of the most critical issues that should be solved in the nearest future. They state that all people should have an equal opportunity to be healthy. Unfortunately, “disparities by race and ethnicity, socioeconomic status, geographic location, disability, and/or sexual orientation” are often faced nowadays (CDC, 2016, para. 8). It means that those people who represent the homosexual population, for example, often experience sexually-transmitted diseases because they lack knowledge, free access to healthcare services, and are treated with prejudiced views even by the representatives of the healthcare services.
APN Practice
Thus, this very bill is likely to initiate positive changes in the framework of an advanced practice nurse (APN) practice. For instance, medical staff will be encouraged to focus on diversity. They will receive additional education considering racial, ethnic, cultural, and other peculiarities of the US population. As a result, they will be expected to use this knowledge in the decision-making process when advocating for their patients. More attention will be paid to the identification of health issues faced by minorities and other small groups of people. Moreover, the management will be encouraged to employ a diverse workforce for the medical staff to understand patients better (Philips & Malone, 2014). Thus, numerous advantages are expected to be faced by both APNs and their patients.
Environment
Several decades ago, scientists and medical professionals associated with health issues mainly with people’s direct environment, such as polluted water and air or unsafe working conditions. However, in recent years, their attention was also attracted by such variables and societal status, cultural peculiarities, ethic norms, economic, political, and legislative factors.
Sociocultural
People’s beliefs and practices vary depending on the ideas shared among them. Medical staff must understand why people act in a particular way and acknowledge how to address them. For instance, representatives of some groups reject medical treatment. In the majority of cases, they happen to those individuals who are members of Fundamentalist Christian faith groups. Nurses should be able to accept their decision to avoid any intervention even if it is needed because they are to protect the patient’s right to select this option instead of insisting on the necessity to change one’s opinion. Unfortunately, it often happens that these patients are threatened by the medical staff or treated like insane people.
As a result, they become not willing to contact healthcare professionals at all and encourage their friends and relatives to do the same. Similar situations also resort to abortions when patients become disregarded, or they receive refusal to terminate a pregnancy until it is too late. Muslim women, for instance, prefer to be treated by female doctors and nurses because they feel ashamed. If this demand is not satisfied, they are not likely, to be honest with their provider of the healthcare services, which prolongs the time needed to make a final diagnosis and leads to adverse outcomes. Issues are often faced by the representatives of the gay communities because some medical workers do not want to treat them with respect and provide all the needed services based on their antipathy to these people (Thomas, 2014). Such actions are considered to be unprofessional and must be eliminated. However, these problems are often observed even today.
Ethical
In the framework of medical ethics, healthcare professionals are expected to do their best to avoid differences in treatment. Enormous attention is paid to the reduction of racial and ethnic disparities, but they are still observed (Chaet, 2014). For example, some nurses and physicians reveal biased behavior towards particular populations, relying on stereotypes instead of meeting the needs of their clients. Often, people’s characteristics prevent professionals from making an effort and reaching the best possible health outcomes.
Every year numerous cases of medical staff’s negligence are reported, which proves that healthcare providers fail to treat their patients with the required respect or just consider their cases to be not very critical. As a result, individuals face those situations when the wrong side of a brain is operated, or pec implants are changed to breast implants. Sometimes, ambiguous cases happen. When a child with one limb was born, his parents accused their doctor of failing to detect this fact through ultrasounds (Griffin, 2013). On the one hand, this situation can be explained by the lack of skills or inattentiveness. On the other hand, this malpractice could have happened because the professional did not want the woman to have an abortion. Nevertheless, such issues would not have occurred if all ethical considerations were considered by medical workers and they acted according to the code of ethics.
Economic
The current economic environment is a thing that promotes disparities among the US population. Unfortunately, a lot of people are not able to afford insurance that is required by hospitals because of their cost. In other words, economic status determines patients’ access to healthcare services. Those who have higher income have an opportunity to obtain more advantageous insurance, which allows them to get needed tests in time, receive the right treatment, and follow-up care.
As a result, their health outcomes are likely to be better than those of the rest of the population, because their diseases can be determined in the early stages and the most effective treatment can be provided. However, those people who have low income and do not receive health insurance as a part of their benefits package at the workplace rarely resort to healthcare providers because they do not have enough money. Moreover, a lot of practitioners refuse to work with these populations as they are not willing to be underpaid. Even though some initiatives focused on the provision of free or cheap insurance are already implemented, numerous people still face this obstacle, which proves that a new approach to improvement should be developed.
Political and Legislative
Even though the majority of healthcare providers claim that their services are included in the basic rights of all individuals, some politicians do not support this idea. For example, being a presidential candidate, Donald Trump claimed that “access to healthcare is a privilege that should be earned, rather than a right” (Hobbus, 2016, para. 1). As a result, now his views are spreading throughout the USA. The acceptance of this idea is likely to affect the overall health condition of the country adversely because those people who represent deprived populations will not receive any assistance in the framework of healthcare. In the future, they all may face adverse health outcomes that will lead to numerous deaths and societal split.
Moreover, the president’s claim encourages medical staff to increase healthcare disparities, preventing some people from reaching the services they need. Legislative environment, on the other hand, seems to be somehow supportive due to the existence of Medicare and Medicaid. These programs are targeted at particular populations, such as children from poor families, pensioners, and military veterans. However, a lot of people who seem to have appropriate characteristics fail to apply for them. Even many individuals from the middle class have problems with insurance, which prevents them from being properly treated or lead to loans. As a result, some of them become depressed and face new issues. Thus, it can be claimed that the current environment requires great improvement. Brand new initiatives should be implemented to reduce health disparities and make all US citizens equal in the framework of healthcare.
Passage/Progression of the Bill
Sponsors
The bill is sponsored by Cory A. Booker. He is a representative of Congress from the Senate who entered it in 2013. Booker resorts to the Democratic Party, which means that he speaks for the US citizens and spreads their ideas. The legislator introduced this bill to the Senate in 2015. It was read twice, which provided all members with an opportunity to focus on the discussed issue and acknowledge a problematic situation related to healthcare. Then it was referred to the Committee on Health, Education, Labor, and Pensions. No other actions were undertaken, so the bill was discussed by the Senate only one day. Even though Booker was the main person in charge of these actions, the bill was co-sponsored by another representative of the Democratic Party. Senator Sherrod Brown from Ohio also considered the issue of health disparities to be critical for the US population. Moreover, both legislators support those bills that deal with the improvement of people’s lives. In this way, it can be understood that they are highly concerned with citizens’ well-being and are likely to do their best to fulfill the bill and reach the desired aim.
Stakeholders
Other stakeholders include the US Senate Committee on Health, Education, Labor, and Pensions. It was expected to attract the attention of the National Academy of Medicine and the Secretary of Health and Human Services to the outlined issue and make them investigate it and develop guidelines that can be used to improve the situation and benefit the representatives of the general public. Unfortunately, it is not clear whether all required actions were undertaken. However, because the Committee “encompasses most of the agencies, institutes, and programs of the Department of Health and Human Services”, it is expected to discuss the reduction of health disparities (The HELP Committee, 2017, para. 1). Moreover, the Innovation Center for the Centers for Medicare & Medicaid Services was involved in these procedures. The sponsors of the Bill urged it to fund initiatives aimed at the reduction of disparities through grants.
It can also be claimed that healthcare providers and consumers were among the main stakeholders of the discussed bill. However, they seem to be more connected with the outcomes of its implementation than with this very process in particular. If the mentioned guidelines were developed, healthcare professionals would face the necessity to resort to it in the framework of their practice. As a result, patients would also experience their influences.
Timeline
The efforts to pass the bill did not encounter any difficulties, which can be said based on the actions that happened to it. Nevertheless, particular difficulties could have been experienced due to the cleavage regarding views of politicians on the accessibility of healthcare services. In addition to that, some detentions could have been observed because of the necessity to involve different organizations and make them perform various actions one by one. As the sponsors of the bill do not discuss similar initiatives anymore, it can be stated that the stakeholders fulfilled their roles, and research of the already used programs targeted at the reduction of health disparities was conducted. Then, guidelines were developed and spread among the medical staff of the US healthcare facilities so that they are now successfully utilized and expected improvement will be observed soon.
Consequences/Effect of the Bill
The sponsors of the bill and parties involved in the implementation of actions needed to reach its aim are likely to face both positive and negative influences. For instance, they are likely to appeal to the representatives of the general public. As these parties attracted the attention of the Senate to those issues that are faced by minorities and other deprived populations, they are likely to create a positive image that ensures consumers’ loyalty. Thus, in case of elections that are conducted through voting, Senators can receive substantial support from the US population, which will improve their career. However, if other politicians believe that their position is not right and claim that disparities are needed to turn healthcare into a privilege, the sponsors will have to deal with the increasing competition and opposition. Those organizations that were involved in the operations discussed in the bill may also suffer from the actions of other politicians because they will be likely to create obstacles that will affect the delivery of healthcare services adversely. For instance, they may refuse to fund or support some initiatives.
According to the bill, healthcare professionals are expected to receive guidelines that they can use when providing patients with needed services. Of course, a lot of them will be not willing to accept and implement changes in practice because they are likely to make the working process more complicated (at least at the beginning). Moreover, those practitioners who do not try to reduce disparities may lose their clients or even jobs, which will have a negative influence on their competitiveness. However, successful implementation of the steps outlined in the guidelines can allow professionals to enhance consumers’ loyalty, streamline the working process, and improve health outcomes for the deprived populations significantly, which presupposes substantial performance improvement.
Finally, those individuals who represent minorities may face issues because of the bill. Medical staff who reject changes can start treating patients even worse, trying to reveal their dissatisfaction. Similarly, there is a possibility that fewer professionals will practice so it will be difficult to receive the needed consultation. However, those nurses and doctors who continue practicing are likely to improve the quality of their services, which will lead to enhanced communication between professionals and an increased number of positive health outcomes. In addition to that, more people will be able to access healthcare services (CDC, 2014). Even if the whole population of the USA will not be treated equally, a great step forward is expected.
Thus, it can be stated that the bill will lead to such short-term 1) issues, as the reduction of service providers, clients, loss of practice, and poor treatment; 2) and advantages enhanced loyalty and quality of services. Long-term 1) issues will include lack of healthcare providers; 2) while advantages will deal with the improved access to healthcare, increased number of positive outcomes, and equal treatment.
Issue/Goal Accomplished
The issue discussed in the bill is also on the current burner for China. Its healthcare professionals focused on the goal of reducing disparities as well. They emphasized the fact that regardless of the rapid economic growth experienced by the country recently, positive alterations fail to be equitable, and benefits are not equally distributed among the whole population, which is also actual for the USA (Wang & Jiao, 2016). Particular aspects of China’s and the bill’s goals seem to be similar. For instance, both of them claim that people’s geographical location, social status, and economic environment differ and affect their access to healthcare.
Even though the bill discusses other risk factors as well, these seem to be the most critical. Still, it fails to pay enough attention to environmental issues. Nevertheless, this can be explained as China is more polluted than in the USA. The association between incidences, mortality, and health disparity is also described by China and in the bill. Nevertheless, the Chinese Government believes that public investment in disease prevention and health promotion with the focus on poor people along with the usage of cost-effective implementations are the most advantageous ways to reach the goal. However, according to the bill, attention should be paid not only to various care models but also to the education of the population.
Thus, it cannot be denied that China is more focused on the financial side of the issue. Its government is willing to consider different options for investment and making healthcare more affordable while the USA considers those initiatives that can be applied by healthcare providers themselves. This discrepancy can be explained by the fact that China has recently increased its funds and is willing to use them while the USA has already tried this option and is now thinking of other opportunities.
Suggestion for Changing the Bill
To improve the outcomes of the bill, the legislators should think of the identification of the most in-need populations. The bill is likely to be more useful if they name one or several groups of people that should be discussed at first. For instance, they can encourage to focus on those disparities faced by African American and Hispanic/Latin population because they represent the main US minorities (Nittle, 2016). As a result, it will be easier for the addressed entities to conduct research and identify those actions that are to be included in guidelines. It will also be beneficial to name a healthcare issue that should be considered beforehand. Considering the text of the bill, this seems to be HIV. If the legislators encourage the entities to focus on it, the aim of the bill will be achieved much faster, as research will be more focused.
References
CDC. (2014). CDC reports on effective strategies for reducing health disparities. Web.
CDC. (2016). Strategies for reducing health disparities. Web.
Chaet, D. (2014). The AMA Code of Medical Ethics’ opinion on disparities in health care. AMA Journal of Ethics, 16(6), 440-441.
Griffin, S. (2013). 10 horrible cases of medical malpractice. Web.
Hobbus, R. (2016). Donald Trump: Healthcare is a privilege, not a right.
Library of Congress. (2016). S.1903 – Reducing disparities using care models and education act of 2015. Web.
Nittle, N. (2016). Interesting facts about racial minorities in America. Web.
Philips, J. & Malone, B. (2014). Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. Public Health Reports, 129(2), 45-50.
The HELP Committee. (2017). Issues. Web.
Thomas, B. (2014). College of health and health care disparities: The effect of social and environmental factors on individual and population health. International Journal of Environmental Research and Public Health, 11(7), 7492-7507.
Wang, Q., & Jiao, J. (2016). Health disparity and cancer health disparity in China. Asia-Pacific Journal of Oncology Nursing, 3(4), 355-343.