Provide a reply as a DNP student, using at leeast 250 words. Use as guide references from the last 5 years (2020-205) different from original post.

8100 to Carmen

 

Decades since its inception, health care systems evolve across the United States from “piecemeal, piecemeal” healthcare into a complex system of care driven by policy with access, quality, and population health outcomes. Health care delivery in the early 1900s, was relatively decentralized, with limited regulation; most people were uninsured. Care was predominantly provided in the home or small community hospital, and public health activities emphasized the management of infectious illnesses with sanitation and immunization. Access to care had largely been determined by socioeconomic status, and when it came to healthcare the federal government paid relatively little or even nothing for health care.

One of the major turning points was in the post-World War II era and beyond that, with the proliferation of employer insurance, the "national health insurance program" that came to be accepted by the vast majority of Americans. These policies, backed by federal-level taxes, encouraged employers to offer health benefits, vastly enhancing access for working individuals. But it also led to disparities for people outside the workforce. Medicare and Medicaid programs that emerged in 1965, which expanded coverage to older adults, disabled persons and low-income Americans, were a key policy intervention.

 These programs changed patterns of health care utilization, sped up the build-out of hospitals and firmly established federal government as the central investor in health care finance. Policy measures increasingly sought efficiency and cost discipline to cope with higher health care charges in the late 20th century. The rise of managed care models like preferred provider organizations—or PPOs—and health maintenance organizations means that to control utilization and coordinate care effort. Policy initiatives have more recently focused on value-based care, preventive services, and outcomes accountability.

The Affordable Care Act expanded insurance coverage, reduced barriers to preventive care and encouraged alternative payment models that incentivize quality and patient outcomes over volume of services. The COVID-19 pandemic has sped up other shifts, from the explosive expansion of telehealth and a renewed focus on public health preparedness to new understandings of health inequities. These historical trends have profound implications for DNP–prepared nurses as they are more likely to practice systems thinking, policy involvement and leadership in quality improvement.

The changes towards population-based and value-focused care map onto AACN Domain 3- Population Health and Domain 5- Quality and Safety as well as Domain 2- Person-Centered Care. By examining how health policy has affected performance of services, DNP leaders build capabilities to assess system performance, promote equitable policies, and provide evidence-based interventions that enhance access, benefits, and sustainability in numerous populations.

References:

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. Washington, DC: AACN.

Gee, R. E., & Spetz, J. (2020). Strengthening the health care workforce to improve population health outcomes. Health Affairs, 39(11), 1871–1878.

Centers for Medicare & Medicaid Services. (2023). National health expenditure projections and policy considerations. Baltimore, MD: CMS.