Health policy is what governments or private institutions choose to do, or not to do, in regard to health. If a choice is made to take action, a formal plan for a course of action is adopted—this is the realm of health policy. Health policy in the public governmental sector mainly focuses on legislative proposals, policy implementation (writing and publishing regulations), and judicial review of policy decisions. In the private sector, policy decisions are made that lay out operational principles to guide action and behavior within an institution. Achieving understanding of current health issues and finding suitable solutions to policy problems have fueled a distinct field of policy research that includes two subfields, that of health services research and that of policy analysis.
Health services research examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. Today’s issues drive the investigations. For example, how will the nation identify and address the most effective ways to organize, manage, finance, and deliver high-quality care for all, and at the same time, reduce medical errors and improve patient safety? Policy analysis uses a comparative methodology that examines how current policy proposals compare favorably or unfavorably with selected criteria.
Criteria are drawn from previous research and a thorough review of the literature on the policy issue. Legislative proposals, in particular, lend themselves to this type of analysis. The need for policy research has grown in importance as the nation confronts the rising costs and inadequacies of present day health care. It has been demonstrated that health policy research can assist in a number of areas, including: the elimination of health disparities; the closure of the gap between the “haves” and “have-nots” in health care; the protection of communities from avoidable health hazards; and the shift from a purely biomedical model, that accorded priority to science and services to treat the diseases of the individual, to one that focuses on population health and the many determinants of health and disease (Boufford & Lee, 2001, p. 1).As governments and the private sector explore suitable policy solutions to the nation’s health care woes, the call for credible health policy is greater than ever.
In the past, both health services research and health policy analysis have been concerned with issues, such as access, quality, and cost of healthcare, with more emphasis on cost than access and quality. Today, there are perceptible changes, principally because consumers of health care are increasingly more vocal and more prominent players. Health care consumers are assisting in moving the health care industry toward increased accountability through evidence-based practice and the elimination of medical errors.
As health care problems increase in complexity, it has become obvious that no one health professional can address all of the is-sues and find all of the appropriate solutions. Within this context, research efforts have be-come increasingly grounded in the multidisciplinary investigations of complex policy problems.
As the largest group of health care professionals, nurses are in an ideal position to collaborate with and lead health policy re-searchers in the exploration of significant areas of concern. To do this, nursing must develop a new dialogue with other health professions and all those who participate in health policy decision making by developing greater flexibility and enhanced collaborative behaviors (Dickenson-Hazard, 1999). Furthermore, many health policy decisions directly influence the practice of nursing. These include: defining the scope of practice, regulation of practice environments, cost of malpractice insurance, government subsidization of nursing education and research, and securing direct and indirect reimbursement for services. Examples of federal agencies within the
Department of Health and Human Services(DHHS) that directly impact nurses are: the Health Services and Resource Administration(HRSA) and, in particular, the Division of Nursing; the Centers for Medicare and Medicaid Services (CMS); and the National Institute for Nursing Research (NINR).Four interrelated characteristics of present-day health care systems have significantly shaped health policy and will continue to influence the practice of nursing now and in the near future.
These characteristics are: systemic change, interdependence, financial viability, and the changing face of the health professions. The ability to adapt to systemic change within the health care system, the movement toward the interdependence of all health care providers (along with the changing face of the health professions), and the realization that financial viability drives and determines which health care institutions and systems of care survive and flourish (Jennings, C. P., 2000).
Taken as a whole these characteristics provide the context for nursing education, practice, and research. Participation of nurses in the shaping of health policy and public health policy is critical for the future of the profession and the well-being of all citizens (Algase, BeelBates, & Ziemba, 2004). Political participation goes hand in hand with policy development. Political participation or action is not new to nurses. For many years nurses have advocated for issues that promote the profession—money for education and research, scope of practice concerns, reimbursement for services by third-party payers, and more recently the passage of the Nurse Reinvestment Act (a federal effort to combat the nursing shortage).
Today, nurses are lobbying to secure “a place at the table.” They are active participants in setting the broader health policy agenda. Nurses have been influential in developing protocols for first responders in bioterrorist attacks; they have challenged some of the key provisions in the Medicare Prescription Drug Benefit legislation; they have fought to expand access to primary care services in rural and underserved areas; and they are strong proponents for universal health care. Health policy is a worthy and exciting arena for nursing practice. It includes the political imperative to participate in all phases of the policy and political cycle.
Achieving “political maturity” is a goal that requires that each and every nurse have the proper education and skill development to effectively intervene in the policy process in order to achieve professional and national goals for long-term health and well-being. Nursing organizations, such as the American Nurses Association (ANA), lobby on behalf of all nurses. Often, organizations such as the ANA are able to directly interface with policy making bodies at the local, state, and federal level.
It is important that nurses develop effective channels for communicating with policy decision makers. In closing, nurses must remember that the relationship between nursing and health pol-icy is reciprocal and mutually reinforcing-herein lies the greatest hope for the future of nursing and the nation’s health care.