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Literature Review on Health Policy and Policy-Making Process
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Literature Review on Health Policy and Policy-Making Process
Introduction
Various legislations have shaped the current healthcare policies and the policy-making
process. The Health Insurance Portability & Accountability Act (HIPAA) protects the health
insurance coverage of employees and their families, hinders healthcare abuse and fraud, and
establishes national identifiers for health insurance plans, employers and healthcare providers.
This legislation has presented changes to medical insurance deductions, health insurance law and
health coverage modifications (Benton et al., 2023). On the other hand, the Affordable Care Act
(ACA) has allowed millions of individuals to acquire medical coverage leading to improved
access to healthcare services. The Medicaid program covers people with annual incomes and
enables millions of uninsured individuals to acquire coverage. Moreover, the Mental Health
Parity Act (MHPA) is a vital federal law that applies to group health plans based on annual and
lifetime limits. Besides, the Emergency Medical Treatment and Labor Act directs that people get
public access to emergency services regardless of their ability to pay while the Paper Reduction
Act plays a crucial role in healthcare policy (Hajizadeh et al., 2021). Therefore, the literature
review examines how these legislations have enabled nursing organizations to influence policies
that improve patient outcomes and positively impact the healthcare system, including the nurse’s
involvement in policymaking.
Background
Healthcare policies are implemented to enhance better health outcomes. It encompasses
the actions, plans, and decisions established to enhance better healthcare for individuals. Nursing
organizations including professional associations, regulatory bodies, specialty nursing practice
groups, and nursing student groups at all levels have a greater role in influencing multiple health
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legislations and policies. Chiu et al. (2021) indicate that nursing organizations engage in the
advocacy of policies that influence the privacy, rights and access to care of patients. The Health
Insurance Portability & Accountability Act (HIPAA) focuses on healthcare coverage access to
employees and their families. Besides, its provisions emphasize on the protection of health
information and the prevention of healthcare abuse and fraud as well as the development of
standards that can ensure healthcare system efficiency (Chiu et al., 2021). Edemekong et al.
(2018) explore the role of the American Nurses Association (ANA) in privacy rules under the
HIPAA legislation which facilitates the documentation of privacy procedures, policies, and
disclosures about healthcare providers, health plans and health insurers (Edemekong et al.,
2018). This has transformed the healthcare systems whereby the privacy rule directs that
healthcare providers grant patients the right to access health information, improving the
efficiency of healthcare systems and standardizing healthcare transactions.
The Affordable Care Act has improved healthcare delivery, patient care and access to
insurance coverage for the uninsured or underserved populations. Ercia (2021) examines the
ethical guidelines and professional standards established by the American Nurses Association to
shape the regulatory framework for ACA and HIPAA provisions. There is a major focus on
healthcare quality, outcomes and data privacy, the involvement of nurses in policy-making, and
how they can use health policy to improve quality healthcare and patient safety (Ercia, 2021).
The International Council of Nurses focuses on quality nursing for everyone and the
establishment of essential policies for all globally. Nurses have a role in regulatory changes and
the Affordable Care Act addresses various healthcare policy requirements and identifies three
reform aims such as increased access, quality care and limited healthcare expenses. This has led
to the preservation of employer-based Medicare and coverage and expanded Medicaid.
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Hsuan et al. (2019) assert that nurses have an integral role in healthcare finance
sustainability concerns based on collaborations with policymakers, administrators, and
legislators. The American Medical Association (AMA) elaborates on the need for policy change
including the integration of legislation such as the Emergency Medical Treatment and Labor Act
(EMTALA) (Hsuan et al., 2019). Physicians are guided by ethical and legal responsibilities to
provide appropriate patient care. However, the American Medical Association provides insights
into how EMTALA obligations often influence administrative challenges, uncompensated care,
and the overuse of physician resources. Hegner (2019) explores the influences of policy changes
in ensuring the efficient use of resources and compensation of care. Mental health nurses have a
major obligation to advocate for improved and quality mental healthcare while addressing stigma
and treatment interventions for individuals with mental health illnesses (Hegner, 2019). Thus, the
collaborative efforts of nurses and nursing organizations help ensure the provision of emergency
care services to all patients including those lacking the ability to pay.
In various healthcare systems, the Emergency Medical Treatment and Labor Act
(EMTALA) has been integrated to facilitate health policies regarding emergency care and the
role of nurses. Hsuan et al. (2019) examine how the Mental Health Parity Act (MHPA) has been
established to allow healthcare providers to cover mental health, enabling access to many people
seeking mental health treatment and services for mental illnesses. This has been a major step
towards inclusivity in healthcare access as well as the provision of comprehensive patient care.
Nursing organizations and nurses drive positive changes through collaborations with
policymakers and advocacy (Hsuan et al., 2019).
The American Nursing Association guides nurses in undertaking advanced learning in
health policy and serving on advisory boards whereby engagement with policymakers shapes
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policies on affordable care. Ercia (2021) indicates that although the Affordable Care Act (ACA)
has facilitated increased coverage for patients especially those from low-income areas,
challenges to healthcare providers have affected policy changes and the provision of care in
healthcare systems. ACA promoted new payment models, and new reporting requirements,
influencing administrative burdens that affect healthcare providers (Ercia, 2021). Similarly, there
are increased costs of compliance for healthcare organizations and providers who have to adhere
to HIPAA regulations by investing in compliance measures, facilitating higher administrative
costs.
The National League for Nursing (NLN) is an essential nursing organization that enables
nurses to access public policy initiatives important in advancing national and global community
health through policy changes. Inayat et al. (2023) demonstrate how the Advocacy Action Center
services allow nurses to take an active responsibility in public policy including changing current
policy issues facing healthcare systems. This ensures that policy changes focus on the health
issues affecting nurses and the National League for Nursing (NLN) supports various legislations
through lobbying efforts (Inayat et al., 2023). There is a major influence on the congress, federal
agencies and state governments to enact laws that support nurses and nursing students. The NLN
supports the Paper Reduction Act which facilitates the minimization of health costs.
According to literature, policy advocacy focuses on the accountabilities and
responsibilities of nurses and the role of nursing organizations which provide a platform for
policy changes in healthcare systems. In nursing, advocacy enables nurses to engage in public
policy, health systems, and improving patient care. Scott & Scott (2021) indicate how nursing
organizations are vital platforms for policy changes and help nurses build advocacy skills and
multiple advocacy groups shape policy outcomes, processes, and agendas (Scott & Scott, 2021).
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Paperwork Reduction Act was created to limit paperwork burden imposed by the federal
government on citizens and organizations. Shapiro (2018) shows how it ensures quality and
limited burdens on public information collection including the collection and documentation of
patient information in healthcare systems. Minimizing the collection of information burden
entails the use of technological, electronic, and automated techniques (Shapiro, 2018). The
Paperwork Reduction Act helps nurses limit long working hours and fatigue which can affect
well-being and lead to medical errors in facilities.
Conclusion/ Recommendation
Multiple legislations have impacted current healthcare policies including influencing
policy changes regarding the safety, and well-being of nurses and patients across healthcare
systems. The existing research has shown that various nursing organizations such as the
American Nurses Organization (ANA), American Medical Association (AMA), and the National
League for Nursing (NLN) play a great role in influencing policy as it relates to legislation
including Affordable Care Act (ACA), Health Insurance Portability & Accountability Act
(HIPAA) and the Mental Health Parity Act (MHPA). Other legislations that are facilitated by
policy advocacy of nurses are the Emergency Medical Treatment and Labor Act (EMTALA) and
the Paperwork Reduction Act. Also, the literature highlights the impact of this policy across
healthcare systems including the role of nurses in improving quality healthcare and outcomes for
everyone. Care coordination and medical coverage minimize healthcare costs and nurses have
been involved in policymaking through engagement with policymakers, legislators, advocacy
advisory boards and professional organizations. However, there are several gaps associated with
the nursing organizations’ role in policy making including assisting nurses to gain advocacy
skills and enabling them to engage in advocacy work through advanced education. Therefore,
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future research and knowledge are required to ensure extensive insights into health policy,
legislation, the policy-making process, and the impact of policy change on patient care and
health outcomes.
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References
Benton, D., Ferguson, S., & Del Pulgar, M. G. (2023). Exploring the influence of the nursing and
medical professions on policy and politics.;Nursing Management,;30(5).
https://journals.rcni.com/nursing-management/evidence-and-practice/exploring-the-
influence-of-the-nursing-and-medical-professions-on-policy-and-politics-
nm.2020.e1896/pdf
Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy advocacy and
nursing organizations: A scoping review.;Policy, Politics, & Nursing Practice,;22(4),
276-296. https://journals.sagepub.com/doi/full/10.1177/15271544211050611
Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2018). Health insurance portability and
accountability act. https://www.ncbi.nlm.nih.gov/books/NBK500019/
Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care:
perspectives from FQHC administrators in Arizona, California, and Texas. BMC health
services research,;21, 1-9.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06961-9
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021).
Factors influencing nurses participation in the health policy-making process: a systematic
review.;BMC Nursing,;20, 1-9. https://link.springer.com/article/10.1186/s12912-021-
00648-6
Hegner, R. E. (2019). Mental health parity: unresolved issues affecting employers, consumers,
and insurance coverage. In;Issue Brief (George Washington University. National Health
Policy Forum);(No. 709, pp. 1-12). https://www.ncbi.nlm.nih.gov/books/NBK559473/
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Hsuan, C., Horwitz, J. R., Ponce, N. A., Hsia, R. Y., & Needleman, J. (2019). Complying with
the Emergency Medical Treatment and Labor Act (EMTALA): challenges and
solutions.;Journal of Healthcare Risk Management,;37(3), 31-41.
https://onlinelibrary.wiley.com/doi/abs/10.1002/jhrm.21288
Inayat, S., Younas, A., Andleeb, S., Rasheed, S. P., & Ali, P. (2023). Enhancing nurses'
involvement in policy-making: A qualitative study of nurse leaders. International
Nursing Review,;70(3), 297-306.
https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12828
Scott, S. M., & Scott, P. A. (2021). Nursing, advocacy, and public policy. Nursing ethics,;28(5),
723-733. https://journals.sagepub.com/doi/abs/10.1177/0969733020961823
Shapiro, S. (2018). The Paperwork Reduction Act: Benefits, costs, and directions for reform.
Government Information Quarterly,;30(2), 204-210.
https://www.sciencedirect.com/science/article/pii/S0740624X13000087
