hi I'm Dr Joy Fletcher chairs DMP faculty at charity School of Nursing since 2018 adult Health nursing level one nursing 113 this lecture is on Health Care policy Healthcare policy is put in place as we are taking care of our patients and we're nursing at the bedside and other capacities of nursing uh what matters most to us is patient care uh however we must be aware of some of the health care policies and so this lecture is just a short lecture put in place just so we know uh what we're looking at with Health Care policies and basically it's making sure that everyone has access to healthc care we're basically seeing everything from the other side uh Access to Health Care uh for everyone basically when we divided uh the United States looking at health care and access to health care it was basically determined that there were uh three different levels basically there was the patients that had Insurance uh there was the uninsured are the ones who had no insurance at all and then there was the underinsured uh which are the patients that have insufficient coverage again when we're at the bedside and we're taking care of patients none of that matters to us uh we're basically making sure that we're providing uh quality patient care but the national healthc care disparities report mandated steps to accessing health care and basically this started in 2020 with the healthy people 2020 initiative which basically said that everyone would gain entry into Health Care Systems that everyone would have access to sites of care where patients can receive the needed services that they needed and basically access to healthcare meant finding providers with whom patients can communicate and develop a rapport so there was a lack of health insurance this was a global concern this was a global issue basically the lack of health insurance when healthy people 2020 initiative started it was in 2010 uh and basically what it did was it said that in 10 years we're going to close the gap to health disparity we're going to make sure within the next 10 years that everyone has adequate access to health care and so what happened in 2011 after only a year it was determined that there were 48.6 million uninsured Americans and so healthy people 2020 initiative took place and access to care was provided and different systems were put in place and then in 2015 5 years after the plan had been in place it was determined that 37 million Americans were now un insur so you see that the Gap was closed a little bit in the first 5 years in 2020 88.6% of people or 28 million Americans did not have health insurance at this point uh so basically from in that 10year span it was the gap with lack of healthcare and lack of insurance was closed from 48.6 to 28.0 million and so then in 2021 there was an estimated 9.6 million residents uh which is 31.1 million people who lacked insurance now if you noticed in 2020 there was 28 million and we were trending in the right direction from 2011 with 48.6 million to 2015 with 37 million and so we were closing that Gap and when we got to 2020 there was 28.0 Million but then when we flipped to 21 we went back up we started trending in the opposite direction with 31.1 million people what do you think happened and that span between 2020 and 2021 I'm sure you've guessed it absolutely you're correct we had a national pandemic covid-19 came out people lost jobs people lost insurance people lost health care and so we started trending back in the opposite direction so I'm anxious to see in 24 where we stand uh with the National Health interview survey that'll come out by the centers of Disease Control so basically there was a lack of usual source of care uh medical or Health Care a children's and families uh basically what healthy people 2020 did was uh try to seek ongoing uh health care for patients and families uh continuing to try to serve the Gap to better serve uh the usual Health Care sources um the goal remained that people would likely experience appropriate high quality care that no matter what their insurance provider was that they had the access to the same level of care as anyone else that all Americans were equal and that it didn't depend on what your insurance was what your job was what your income was what kind of Health Care you had basically it meant Health Care to access to health care uh was for everyone that it it it had no discrimination on who you were and that you didn't get a certain treatment because you didn't have a certain insurance that if you met the diagnosis criteria that you would have access to healthcare what was discovered was that there of course was an uneven distribution of health care services that patients not always were able to access their own need for care uh the results included delays in care higher health care costs uh certain Geographic populations were under underserved and that there were increased number of specialized health care providers in certain areas and so healthc Care Solutions came about and so here are some of the things that were used uh to close Gap to make sure that everyone had access to that uh Medical Care uh there was the Affordable Care Act uh there's Medicare for older adults 65 and over uh there's Medicaid uh for those with lower incomes uh there's the chip program uh in Louisiana we call it the lot chip program this program makes sure that every kid has access to Medical Care that no matter what their financial situation is that every child can be vaccinated that every child would have access to the same level of care no matter what no matter who no matter where there's also local Health departments and community health centers uh and then basically what happened there were different uh needs and different changes and different short shortages that were uh due to kind of continue to increase and so Healthcare organiz ganizations had to step up uh there are now over a half a million Healthcare organizations and they all have one common purpose and that is to provide healthc care Delivery Systems to everyone each organization has its own unique Mission uh they have their own unique Financial classification they have their own unique uh ownerships uh we see some of these healthc Care organizations in the form of different insurance companies uh you have Blue Cross Blue Shield you have human you have United healthare uh you have Edna you have all these different Health Care insurances all these different Health Care organizations uh they all have one common purpose and that is to provide healthc care delivery services uh to Americans to everyone uh but they all have their own mission and their own Financial classification and they're all owned by different person uh Healthcare organizations these are other healthc Care organizations that help to close the gap that help to bridge the gap to make sure that everyone has access to care uh there's Public Health units there's private physicians offices uh everywhere you go it doesn't matter where you are physically right now you could probably walk out the door and not travel too far and see an urgent care or an Ambulatory Care Center uh these centers are everywhere now and so basically they are there to provide access of to care uh to everyone they're occupation health clinics uh these clinics are used for uh patients who are at work some of the plants uh some of these Big Shell Oil plants and uh these different refineries have occupational health clinics located inside of their establishments uh some of their employees work long hours uh if you get sick at work you can go down to the health clinic you could have your immunizations there uh you could have well visits there you could have sick visits there uh and basically this just allows those working Americans uh access to care uh there are hospitals uh which are acute settings uh you go in through the emergency room and then you have acute care at these different facilities there are also Subacute care facilities uh these Subacute care facilities are for post uh acute uh their skilled nursing homes and long-term care uh facilities more now we're seeing retirement homes and assistant living facilities uh where you see that Americans are getting older they're selling their homes they're moving into assistant living facilities they don't have to worry about keeping up the grass Now assistant living facilities are different from nursing homes because assistant living facilities are actually elderly apartment complexes they are rooms uh they have kitchen Nets uh they don't necessarily all have a stove inside of them but there are kitchens and they're refrigerators and they're just like regular apartments that husband and wife can live in or an elderly uh patient can live in but what happens in those assistant living facilities is you go down to the dining area for lunch and breakfast and dinner or you could bring your food back to your room uh basically you live independently in these assistant living facilities uh but just basically need someone to help you cook um some patients are there because they have lost their spouse and they want to get active in the community with some of the different things and activities that's going on so assistant living facilities are now becoming more and more popular there are also rehabilitation centers uh there are home health care agencies these agencies come and take care of patients at home uh if it's deemed medically necessary the insurance company will cover some of the cost of that uh there are daycare centers daycare centers are just like daycare centers uh for children there are adult daycare centers uh if you are taking care of an elderly parent who maybe um has some early stages of Alzheimer's or dementia and you can't leave them home by your by themselves but you absolutely have to work uh so you can bring them into those adult daycare centers there is Hospice Services for end of Life Care uh hospice is usually you must meet criteria by having a terminal illness uh that you think uh will be uh 6 months of less uh lifespan uh Hospice Services I've seen longer than that uh but there are both inpatient and outpatient Hospice Services Hospice Services can be uh in your home or it can also be impatient in the facility uh just depending on the needs of the family hospice provides uh an array of services uh it provides nursing uh home health aids there are chaplain and social workers and and different things uh basically what hospice does is make sure that patients have high quality Care at the end of life uh making sure that patients have everything they need not just the patient but uh patient family uh and the goal of hospice care is Comfort Care uh to make sure that the patients are comfortable and not experiencing any pain our respir services are are uh in with Hospice Services some of these respit services are uh patients are at home on hospice and um if a family member has to leave and go out of town or do something or there's work being done at the house then if a patient's on hospice they can go impatient uh to respit services for uh a couple of days 5 days 5 to 7 days and then they can come back home and this is a service that's offered by hospice care and then there are also these Crisis Intervention centers uh which we absolutely need more of but uh crisis centers are uh everywhere now and they're becoming uh more and more in demand but these are some of the organizations and some of the facilities uh that are there so that it doesn't matter what level of care you require that there is somewhere and something that you can do or some somewhere that you can go to make sure that your medical needs are being taken care of uh these uh agencies are regulatory accredited agencies uh they function to help providers and agencies operate uh and agencies uh have typical typically they are laws that are enforced uh and they are individual regulated by licensed board um this basically means that uh there's Regulatory and there's accreditation and so there are certain standards that you have to meet you can't just go and say okay I'm going to take this house and this house is now an assistant living home and I'm just going to make it an assistant living home I'm going to take elderly patients and I'm going to just let them live here there are certain standards and certain things that you have to do to be accredited by the board uh they are regulatory uh and accreditation of course um they promote uh they both promote safety and quality uh they are nonprofit uh the regulatory a government run and the accreditations are uh independently owned uh there are also established rules and regulations uh with regulatory and then and as mandatory participation which means that you have to at least have these regulatory uh obligations in order to be uh mandated by the state as a facility and then there's the accreditation process I don't know how many of you have ever worked in the hospitals uh where there's Joint Commission that comes through when Joint Commission comes through everybody knows that um you should always be doing what you what you're supposed to do and what we say we do but everybody knows that when Joint Commission comes through uh everybody's doting their eyes everybody's crossing their tees and they basically come through uh and almost they just kind of go through everything and do an inspection and make sure uh that everything is uh up to standards like it should be uh it's a voluntary participation but it's important for reimbursement uh which is also contended on accreditation so uh a lot of our hospitals in our area are joint commission accredited uh that means that they receive uh more reimbursement for their patient population uh for example if there's a hospital that has um that is Joint Commission accredited they may get $2,000 for a certain Hospital State uh as opposed to a hospital that had the same patient in the hospital they would only receive maybe half of that because they're not Joint Commission accredited and so of course the hospitals want to be Joint Commission accredited uh because they're going to get a higher reimbursement and then there are federal state and local agencies that are uh available uh the US Department of Health and Health and Human Services uh we have the FDA or the Food and Drug Administration we have the CDC uh are the Centers for Disease Control we have CMS uh which does reimbursement centers for Medicare and Medicaid uh we have OSHA which is occupational safety and health administration um some of the State Health policies regulations mandated in conjunction with f Federal policies uh and then we also have the Louisiana Department of Health and hospitals here in Louisiana our vhh and The Joint Commission or JC uh that we just spoke about that basically sums up our brief lecture on Health Care policies uh there is a discussion board if you have any questions please feel free to reach out uh via discussion board also if you need to contact me my email address is J C H A iir dcc.edu thank you for your time