Introduction
As a family nurse practitioner, the wellness and health of patients are at the forefront of my work life. Many professionals such as myself work within the healthcare industry and see a need for comprehensive change. There are several potential avenues for improvement, many of which have the potential to significantly improve patients’ well-being. However, it is necessary to focus on one issue at a time, carefully considering the potential approaches to solving it. For this policy proposal, the topic of price transparency in healthcare will be discussed.
Suggested Policy Changes
Current Policy Structure
It is becoming increasingly important to be able to provide good healthcare services to people, including better access to medical treatment and affordable medical practices. Medical professionals have an ethical and professional responsibility to work toward improving the lives of their clients. Many countries around the world are using free or government-subsidized systems of healthcare, and the US locally experiments with similar programs. Affordable universal healthcare programs have long since been in development in states such as Massachusetts, but significant strides toward progress remain (Day, 2021). To help struggling individuals recover from the financial and physical effects of the present health crisis, it is a necessity to streamline the healthcare delivery process and enhance its reach, efficiency, and scope.
The Rationale for Policy Change
In recent years, legislation regarding price transparency has been put in place across the US. Both healthcare insurance providers and hospitals are now required to submit more transparent information that is relevant to their consumers. However, the process of ensuring complacency and full data provision takes a significant amount of time. Many people are still unable to quickly assess how much money their healthcare will cost, or get access to the required information in time (Szumigalski, 2019). The lack of proposed transparency impedes the quality of healthcare delivery.
Furthermore, many hospitals and insurance organizations are fully failing to comply with the new legislation. According to a recent report published by the Patient Rights Advocate this month, only 14.3% of reviewed hospitals have complied with the ruling. In addition, over a third of all compliant organizations posted insufficient information on their websites (Semi-annual compliance report, 2022). The report also notes that the fee for not following government regulations is considerably low, ranging from $300 to $5500 per day (Semi-annual compliance report, 2022). No fines have been currently issued (Semi-annual compliance report, 2022). The lack of accountability and insufficient financial incentive makes it easy for hospitals to overlook the need for providing transparency for patients.
Design Strategies
Problem Setting
The current policies are incapable of enforcing needed change, and organizations are largely non-compliant with government regulations. Reinforcement methods for adopting transparency practices are not sufficient to encourage change. People are finding access to affordable healthcare services confusing and difficult. In the face of current global conditions, medical institutions seek to reduce costs, while governments and citizens are interested in the improvement of healthcare delivery. The new policy needs to build better reinforcement strategies and encourage change in hospitals and other organizations.
Problem Formulation
The application of harsher methods for building healthcare institution complacency is necessary. By increasing the financial burden of non-compliance, it is possible to make more hospitals adopt transparency measures. In addition, a system of evaluating the degree of transparency provided must be put in place by regulatory institutions. Due to this approach, medical institutions will be less likely to disregard the transparency act, granting patients more choices, while also reducing costs for unnecessary medical procedures.
Agenda Setting Strategies
With the emergence of the current pandemic, the questions of healthcare delivery, costs, and the functionality of the US healthcare system as a whole are coming into prominence. Politicians, media figures, and other professionals increasingly recognize the existence of serious faults in the way healthcare organizations can provide care, and in the ability of the majority to pay for their health. Therefore, the present is the best time to further discuss improvements to the systems connecting with healthcare. The need to aid people in procuring affordable and timely health services can be noted as the main driver of change, along with the lack of action from major medical organizations.
Evaluation Strategies
As a method of evaluating the impacts of policy changes, the total amount of hospitals compliant, partially compliant, and non-compliant with the price transparency legislation can be accessed. By taking hold of this data, it is possible to estimate whether the financial incentive for medical institutions is sufficient in ensuring price transparency.
Cost Implications and Implementation
Stakeholders
Both healthcare professionals and patients are the primary stakeholders in the process of improving price transparency. Patients want to have a better understanding of how healthcare costs are formed, as well as be more capable of choosing how much they have to pay for a service (Vogenberg & Santilli, 2018). As the costs of healthcare are continuously rising, price transparency becomes a more vital component of choice and a reasonable expectation. Medical professionals who must meet the demands of their clients also represent important stakeholders. Doctors, nurses, and others have a professional incentive to assist their patients and promote their wellness. In addition, the push towards price transparency helps to both establish informed consent and bolster patient agency.
Costs and Structure, Role of Nurses
Change can be accomplished through collaborative advocacy of all involved parties, including patients, healthcare providers, and the involvement of politicians. The second part of the change strategy, however, involves introducing a comprehensive framework to the process of price transparency (White & Liao, 2021). Kotter’s 8-step change model can be effectively used to facilitate change. The model has been previously used in healthcare settings and possesses the desired components for systematizing management practices (Seefeldt et al., 2022). Nursing professionals can be used as vital assets for introducing change. Their leadership competencies and knowledge in healthcare delivery will be a necessary bridge between the needs of patients and medical workers. The first step towards bringing change is to develop a sense of urgency. Showing the hospital management that price transparency contributes to both better demand for healthcare services and patient wellness can be an effective way to start the conversation (Kobayashi et al., 2019). Research shows that price transparency is likely to reduce healthcare expenditure, helping medical organizations work in the long term (Wang, 2018). The next step involves finding the right professionals to spearhead change. As noted previously, the unique position of nursing leaders among their coworkers lends itself well to introducing change, while also being capable of systematically overseeing various processes.
The third step of the process consists of creating a vision for change. In the case of medical organizations, such a vision includes full-price transparency, as well as the ability to quickly inform patients of the potential costs of the most common services. Values of honesty, integrity, and patient cooperation must be taken into account for this part of the process. Communication of the vision of change, the 4th part of the process, can be done through concrete plans for enhancing transparency – relevant staff training, the process of categorizing information, and updating public websites for the medical organization.
Step 5 of the Kotter method consists of removing obstacles. Major roadblocks in the process are resistance to change and technical difficulties of data provision. Both of these problems can be solved through proper staff training and education. Short terms goals towards bringing transparency into healthcare must be set, including milestones for services covered in the pricing overview, and staff education goals. During the process of change implementation, the effectiveness of education and the results of the process must be analyzed by management, as a way to ensure smooth future proceedings. Lastly, the idea of medical transparency, as well as pricing transparency, must be cemented in the culture of the organization.
Positive and Negative Financial Implications
As noted previously, the process of ensuring healthcare transparency can reduce medical costs for hospitals, and also increase revenues. Research articles note that clear pricing of medical expenses helps patients make informed choices, and saves organizations money on healthcare expenses (Wang, 2018). In addition, a study on the subject has shown that, in some cases, a push toward price transparency lead to increased patient spending, which can be beneficial to the revenues of hospitals (Zhang et al., 2020). In terms of negative financial implications, it should be noted that staff training and changes on hospital websites would comprise the primary expenses for the process. Further implications of the process will need to be examined in the future.
Conclusion
In conclusion, the introduction of price transparency into the healthcare system as an inherent part of hospital operations is a necessity of the modern medical sphere. With the increasing costs of healthcare treatments, providing patients will a full overview regarding payments becomes vital in promoting their well-being (Reed, 2019). Legislation aimed at increasing accountability can be a sufficient way to incentivize medical organizations to be more thorough in their compliance. The use of nurses as a mediator of change reflects their position as the main agent of patient advocacy, while also taking advantage of their professional competencies.
References
Day, R. (2021). What’s next: The push for Universal Healthcare.The Affordable Care Act as a National Experiment, 109–121. Web.
Kobayashi, D., Goto, R., & Tsugawa, Y. (2019). Impact of improved price transparency on patients’ demand of healthcare services.Social Science & Medicine, 235, 112390. Web.
Reed, R. (2019). Costs and benefits: Price transparency in health care. Journal of Health Care Finance, 45(4). Web.
Seefeldt, T., Perumal, O., & Tummala, H. (2022). Reshaping Pharmacy and Allied Health Education for a post-pandemic world using Kotter’s Change Model. Advances in Medical Education, Research, and Ethics, 96–117. Web.
Semi-annual compliance report 2022. PatientRightsAdvocate.org. Web.
Szumigalski, K. (2019). Why we need price transparency in healthcare.Harvard Public Health Review, 22, 1–4. Web.
Vogenberg, F. R., & Santilli, J. (2018). Healthcare trends for 2018.American Health & Drug Benefits, 11(1), 48–54. Web.
Wang, R. (2018). Price transparency and healthcare costs: The case of the New Hampshire healthcare market. Tulane University, 1–37. Web.
White, A. A., & Liao, J. M. (2021). Policy in clinical practice: Hospital price transparency. Journal of Hospital Medicine, 16(11), 688–690. Web.
Zhang, A., Prang, K.-H., Devlin, N., Scott, A., & Kelaher, M. (2020). The impact of price transparency on consumers and providers: A scoping review. Health Policy, 124(8), 819–825. Web.