Introduction

Individuals who suffer from a systemic or causative illness may experience organ failure or organ disease that, if not replaced, would result in death. Approximately 7500 individuals die annually while waiting for a life-saving organ transplant (DeRoos et al., 2019). The recipient list is extensive compared to the number of donors. In 2018, 74.63% of individuals in need of a transplant failed to receive one due to the gap in supply and demand (Lewis et al., 2021). Specific criteria must be met to be placed on the recipient transplant lists. This waiting list criterion ensures that the organ is going to a deserving recipient who will not misuse their blessing at a second chance at life, especially if specific lifestyle changes had to occur and be maintained, such as alcoholics who need a liver transplant (Lewis et al., 2021). While particular criteria are in place to ensure that deserving individuals receive vital organ donations from both live and deceased donors, it is essential to ensure the individuals are not being discriminated against, intentionally resulting in them not receiving a necessary organ donation based on race, gender, or disability (DeRoos et al., 2019).

Senate Bill S.3301-Charlotte Woodward Organ Transplant Discrimination Prevention Act

Discrimination can occur in many different forms, but Health Bill S.3301, introduced by the Senate, distinctly focuses on eliminating discriminatory practices toward individuals with mental or physical disabilities who need an organ transplant (Congress.gov, n.d.). Having a mental or physical disability should not determine if one should or should not be allowed to have a second chance in life if a transplant is needed. Several Acts have been signed into law, such as The Americans with Disabilities Act of 1990, the Rehabilitation Act of 1973, and the Patient Protection and Affordable Care Act, which are supposed to protect individuals with disabilities from discrimination (Congress.gov, n.d.). However, within these Acts, there are no explicit sections prohibiting discrimination against organ transplants to individuals with mental and physical disabilities, allowing discrimination to occur. S.3301 defines what a qualified individual for transplant is while carving out sections that address individuals with physical and mental disabilities directly to eliminate gray areas that allow room for objective interpretation leading to discrimination (Pendo, 2021).

Background & Social Determinants

Charlotte Woodward, a 34-year-old woman who was diagnosed with Down Syndrome, is an activist in fighting for equal rights for individuals diagnosed with a disability who may not receive fair healthcare or procedures. She was informed that she needed a heart transplant due to a hole in her heart and malfunctioning valves (Norlian, 2021). Many individuals diagnosed with Down Syndrome experience heart defects and may eventually need surgery or, more extensively, a transplant (Norlian, 2021). Unfortunately, many of those same individuals are discriminated against and do not receive transplants based on their disability alone. Charlotte decided to use her platform to advocate for individuals with disabilities and to demonstrate that a disability cannot define one’s trajectory of life. After many attempts to get her voice heard through numerous letters to Congress, she was finally successful, as this was presented to the floor for discussion (Norlian, 2021). Individuals who have physical and mental disabilities often face issues with healthcare access and quality, which are the main social determinants of health associated with this type of discrimination (Lewis et al., 2021). This bill is focused on ensuring increased inclusivity in all areas of healthcare and eliminating gaps that may occur due to oversight (Pendo, 2021).

Supporting Evidence

Through independent research, several articles demonstrated that there was explicit discrimination against organ transplants for individuals with mental and physical disabilities. There is evidence to support the bill, along with scholarly articles and testimonies of individuals directly or indirectly affected by this type of discrimination. Some research even revealed that some hospital policies use direct language that excludes individuals with disabilities from receiving not only transplants but also other healthcare services (Pendo, 2021). Multiple encounters have been shared that demonstrate the need for this bill to make sure that being medically diagnosed with either a physical or mental disability does not mean that an individual’s life is less valuable than another’s (Pendo, 2021).

References

Congress.gov | Library of Congress. S.3301 – Charlotte Woodward Organ Transplant Discrimination Prevention Act. (n.d.). https://www.congress.gov/

DeRoos, L. J., Marrero, W. J., Tapper, E. B., Sonnenday, C. J., Lavieri, M. S., Hutton, D. W., & Parikh, N. D. (2019). Estimated association between organ availability and presumed consent in solid organ transplant. JAMA Network Open, 2(10). https://doi.org/10.1001/jamanetworkopen.2019.12431

Lewis, A., Koukoura, A., Tsianos, G.-I., Gargavanis, A. A., Nielsen, A. A., & Vassiliadis, E. (2021). Organ donation in the US and Europe: The Supply Vs Demand Imbalance. Transplantation Reviews, 35(2), 100585. https://doi.org/10.1016/j.trre.2020.100585

Norlian, A. (2021, January 4). A woman with down syndrome has fought for organ transplant anti-discrimination legislation for years; now, it’s been proposed, and named after her. Forbes. https://www.forbes.com/sites/allisonnorlian/2021/01/04/a-woman-with-down-syndrome-has-fought-for-organ-transplant-anti-discrimination-legislation-for-years-now-its-been-proposed-and-named-after-her/

Pendo, E. (2021). Equal access to organ transplantation for people with disabilities. Hastings Center Report, 51(4), 4–6. https://doi.org/10.1002/hast.1265

Health Policy: S.1999 — Right to Contraception Act

Bill S.1999-Right to Contraception Act was introduced June 14, 2023, to Congress and the aim was to protect a person’s right to access contraceptives as well as the health provider’s ability to offer contraception and educational information regarding contraception decisions (Congress.gov, n.d.). There have been numerous barriers to individuals having access to contraception due to laws, lack of knowledge, insurance coverages, and a person’s socioeconomic status to name a few. The Right to Contraception Act aims to remove these barriers by safeguarding individuals’ access and healthcare provider’s capacity to provide comprehensive contraceptive services. These barriers restrict equitable access to contraceptive care.

Social Determinant Most Affecting the Policy

I think the social determinant mostly affecting this policy is a person’s economic status. Individuals from lower income backgrounds face challenges with adequate accessibility to contraception, reproductive health care, and knowledge surrounding this topic. This limits their ability to decide about their health, families, and lifestyles (Congress.gov, n.d.). It is also documented that persons of marginalized groups such as people of color, those with disabilities, and individuals with lower wages are most impacted (Congress.gov, n.d.). These differences emphasize the necessity of laws like the Right to Contraception Act, which seeks to remove obstacles and guarantee that everyone, regardless of financial background or marginalized status, has fair access to reproductive health care.

Evidence Base Supporting the Proposed Policy

The first steps in developing a policy and enacting major changes in the country are always problem identification and appropriate analysis, which is based on data and statistics with supporting proof (CDC.gov, 2019). There is sufficient evidence to support the need for the Right to Contraception Act. According to research, access to contraception dramatically reduces unwanted pregnancies, improves maternal and child health outcomes, and enables people to make educated reproductive decisions (D’Souza et al, 2022). A study also showed that Women in lower socioeconomic neighborhoods had poor knowledge about how to access services for contraception and how to use it correctly (D’Souza et al, 2022). These findings highlight the importance of legislative measures like the Right to Contraception Act in promoting health equity and addressing the disparities in access to reproductive health services.

References

Centers for Disease Control and Prevention. (2019, January 2). The CDC policy process. CDC.gov. https://www.cdc.gov/policy/polaris/policyprocess/index.html

D’Souza, P., Bailey, J. V., Stephenson, J., & Oliver, S. (2022). Factors influencing contraception choice and use globally: a synthesis of systematic reviews. The European Journal of Contraception & Reproductive Health Care, 27(5), 364–372. https://doi.org/10.1080/13625187.2022.2096215

Text – S.1999 – 118th Congress (2023-2024): Right to contraception . Congress.gov. (n.d.). https://www.congress.gov/bill/118th-congress/senate-bill/1999/text?s=1&r=51

Health Policy: Inflation Reduction Act of 2022

Description and Background

The Inflation Reduction Act aims to make medications more affordable by allowing Medicare to negotiate drug prices, limit out-of-pocket expenses for seniors, and penalize drug companies that increase prices faster than inflation (Cubanski et al., 2023; Anderson-Cook & Frank, 2024). This policy addresses a long-standing issue in the US, where the high cost of prescription drugs has left many, especially vulnerable populations, unable to afford essential medications (Rapfogel & Gee, 2022). Prescription drug prices in the US are higher than in most other countries, with significant disparities in access due to cost (Cubanski et al., 2023; Commonwealth Fund, 2021). This Act aims to reduce costs by allowing the federal government to directly negotiate prices for high-cost medications with drug manufacturers (Anderson-Cook & Frank, 2024; Rapfogel & Gee, 2022). Right now, private insurers negotiate prices with drug manufacturers, but without the leverage of the federal government, it limits the potential for significant price reductions (Cubanski et al., 2023; Anderson-Cook & Frank, 2024).

Social Determinant of Health

Economic stability, a Social Determinant of Health, affects this policy and is defined as reliable access to resources, such as healthcare, essential for maintaining overall well-being (CDC, n.d.). Many Americans, even those with insurance, struggle to pay for their prescriptions, leading to poor health outcomes (Commonwealth Fund, 2021). The main issue addressed by this policy is the financial burden placed on individuals and the healthcare system due to inflated drug prices (Rapfogel & Gee, 2022). It reflects a broader problem of healthcare accessibility in the US, where many people forego necessary treatments because they cannot afford them (Rapfogel & Gee, 2022). Working in organ procurement, I witness the devastating impact of economic instability firsthand. I see in my own practice that many patients die because they can no longer afford their medications despite paying for insurance coverage. This act will improve economic stability across the US by making essential medications more affordable and accessible (CDC, n.d.; Commonwealth Fund, 2021).

Evidence

The evidence supporting this policy is very strong (Commonwealth Fund, 2021). Countries like Canada and the UK, whose governments negotiate drug prices, consistently pay less for medications (Commonwealth Fund, 2021). The Commonwealth Fund (2021) explains that price negotiations reduce spending and improve patient access to medications, highlighting the effectiveness of this policy approach in controlling costs and promoting public health. By allowing the government to regulate drug price negotiation, the Inflation Reduction Act is projected to save $6 billion across just ten drugs in 2026 (CMS, 2024; Anderson-Cook & Frank, 2024). Moreover, the Act penalizes price increases beyond inflation and is expected to curb excessive pricing even further to ensure better access to affordable medications (Rapfogel & Gee, 2022).

References

Anderson-Cook, A., & Frank, R. G. (2024, August 19). Impact of federal negotiation of prescription drug prices. Brookings. https://www.brookings.edu/articles/impact-of-federal-negotiation-of-prescription-drug-prices/

CDC. (n.d.). Economic stability. Retrieved October 9, 2024, from https://www.cdc.gov/prepyourhealth/discussionguides/economicstability.htm

CMS newsroom. (2024, August 14). Medicare drug price negotiation program: Negotiated prices for initial price applicability. Centers for Medicare & Medicaid Services. Retrieved October 9, 2024, from https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026

The Commonwealth Fund. (2021, May 27). External reference pricing: the drug- pricing reform America needs. Controlling Health Care Costs. Retrieved October 9, 2024, from https://www.commonwealthfund.org/publications/issue-briefs/2021/may/external-reference-pricing-drug-pricing-reform-america-needs

Cubanski, J., Neuman, T., & Freed, M. (2023, January 24). Explaining the prescription drug provisions in the inflation reduction act. KFF. Retrieved October 9, 2024, from https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/

Rapfogel, N., & Gee, E. (2022, August 12). How the Inflation Reduction Act reduces health care costs. CAP 20. Retrieved October 9, 2024, from https://www.americanprogress.org/article/how-the-inflation-reduction-act-reduces-health-care-costs/

Initial post

Week 7 Discussion

Vladimir Berrios- Student ID A01238310

MSN-PMHNP, Walden University

NURS-6050C-40: Policy & Advocacy for Pop Hlth-Fall 2024

Dr. Crystal Dodson

Proposed Health Policy

The chosen health policy is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021, S.1567(Congress.gov, 2021a). I chose this policy because it is very close to my heart. As a bedside nurse of 4 years now, I have seen the struggles and brutal work environments that nurses in general have to contend with. Most nurses got into the role of nursing because they wanted to make a difference and have a heightened sense of compassion. However, for whatever reason, maybe profits based, patient nurse ratios have been ridiculous. Because of these unfavorable ratios, nurses work in unfavorable conditions and patient outcomes are suboptimal (Congress.gov, 2021b; McHugh & Ma, 2014). This is not rocket science, there is no way to take care of so many patients as one person. Unfortunately, what I have seen is burnt out nurses and extremely high turnarounds for nursing jobs. These fast turns result in having floors that are staffed with novice nurses and a float nurse. I see that this is a ubiquitous problem throughout the hospital.

As the name suggests, the purpose of the bill is to create a minimum nurse to patient ratio in hospitals in order to significantly improve patient outcomes. By increasing the staffing, it should reduce the incidence of medical errors by increasing the quality of care and reducing nurse burnout. Of course, this is not just a simple equation based on numbers, the bill rightly also considers the acuity of the patient. Sometimes one patient can feel like seven, therefore, the patient’s level of required care is a very important variable in the equation.

Background

            Of course, there is there is a strong evidence base supporting this policy. Multiple studies have demonstrated that higher staffing levels lead to improved patient outcomes without significantly increasing costs. For example, research by the Agency for Healthcare Research and Quality shows that better nurse staffing improves care quality and reduces patient length of stay without additional financial burdens (Congress.gov, 2021a). Therefore, the background for this policy stems from the growing body of evidence which links higher staffing levels of nurses to be directly correlated with improved patient outcomes, inclusive of lower mortality rates, fewer medical complications, and reduced lengths of stay. The studies coming from California, where nurse to patient ratio laws have been implemented already, show that such staffing improvements lead to better care and higher nurse retention rates.

Social Determinants

            The key social determinant affecting this policy is of course employment conditions, as inadequate staffing often results from financial restraints and leads to cost-cutting measures in hospitals. This inevitably leads to poor working conditions, that lead to dissatisfaction and high turnover among nurses. This high turnover affects the patients because they receive care from often inexperienced and over-stretched nurses. Improving the ratios has the potential to reduce work dissatisfaction and improve the quality-of-care patients receive. In a healthcare system that is already suffering from workforce shortages, this bill seems like the only sober and responsible solution.

References:

American Nurses Association (ANA). (n.d.) Retrieved 2019, July 11, Nurse Staffing https://www.nursingworld.org/practice-policy/nurse-staffing/

117th Congress. (n.d.). Text – S.1567 – 117th Congress (2021-2022): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 | Congress.gov | Library of Congress. Congress.Gov. https://www.congress.gov/bill/117th-congress/senate-bill/1567/text

Stanton, M.A., M. W. (n.d.). Hospital nurse staffing and quality of care: Ahrq archive. Archive. https://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.html

117th Congress. (n.d.). Text – H.R.3775 – 117th Congress (2021-2022): State-based Universal Health Care Act of 2021 | Congress.gov | Library of Congress. Congress.gov. https://www.congress.gov/bill/117th-congress/house-bill/3775/text

Campion, T. (n.d.). Implementing unique device identification in electronic…: Medical care. Medical Care- Office Journal of the Medical Care Section, American Public Health Association. https://journals.lww.com/lww-medicalcare/abstract/2014/01000/implementing_unique_device_identification_in.5.aspx

Main Discussion Post

Over the last decade there has been an increase of federal and state legislation attempting to address the importance of early recognition and treatment of anaphylaxis in schools. The 116^th Congress (2019-2020) introduced H.R. 2468 in May 2019, was passed by both the House and Senate by December 2020, and signed into law on January 5, 2021 (H.R. 2468, 2019-2020). H.R. 2468 (116^th Congress) amended the Public Health Service Act to offer preference in awarding grants related to allergy and asthma to states that met the defined criteria (2019-2020). H.R. 2468 criteria require each state to develop a plan of action for students with known allergies or asthma and must designate a school nurse and other individuals who are responsible for enacting the plan of action for these students (2019-2020). H.R. 2468 requires training for those who designated individuals that includes education regarding identification of allergies and asthma, including “basics, management, trigger management, and comprehensive emergency responses” (2019-2020).

H.R. 2468 (116^th Congress) alone does not put epinephrine auto-injectors or inhalers into schools or make them available to students. There have been subsequent bills introduced that would facilitate actionable change. In 2021 H.R. 4049 was introduced to the 117^th Congress with the name of “Dillon’s Law”, which would “permit a trained individual to administer epinephrine to any individual reasonably believed to be having an anaphylactic reaction” with the training requirements meeting medical standards for the state (2021-2022). This bill also provided protection from civil liability to those who provided aid voluntarily in an emergency (H.R. 4049, 2021-2022). H.R. 4049 did not make it out of the House before the end of the 117^th Congress session. The same bill was introduced to the 118^th Congress in June 2023 as H.R. 3910 – Dillon’s Law and was sent to the Subcommittee on Health; however, as of the closing of regular session in 2024, it remained in Subcommittee (2023-2024).

Current Florida legislation states that public schools are permitted to purchase and stock epinephrine auto-injectors and trained personnel are permitted to administer the medication (State of Florida, 2021). This leaves districts on their own to meet the needs of their students. This may not be an issue for some districts but will be next to impossible for others. There are Federal incentives available to assist with the cost of the medication if certain liability criteria are met by the district regarding trained personnel (State of Florida, 2021). The school districts would still be responsible for establishing their individual policy regarding administration and personnel training. Achieving a functional plan that works to protect students and school personnel may be out of reach for some districts due to the up-front financial implications of obtaining the medication and training personnel on anaphylaxis and medication administration.

The State of Florida has also attempted to address the issue with Florida HB 65 which would require the Department of Education to develop and disclose an anaphylaxis treatment plan for each school district (State of Florida, 2024). It would also require that a certain number of school personnel be trained to recognize anaphylaxis and to administer epinephrine via auto-injector (State of Florida, 2024). Florida HB 65 died in House Committee at the end of the 2024 Florida legislative session. Florida HB 65 did not address potential financial implications of achieving the goal of epinephrine auto-injector availability and training within the schools. It also did not address liability for school personnel in the use of an auto-injector. The bills primary sponsor, Jennifer Harris, has indicated that she will bring a revised and updated bill before the Florida House again in 2025.

Having an allergic reaction can be scary and life-threatening. Imagine a child experiencing the inability to breathe because their throat is swelling closed. Anaphylaxis is a life-threatening allergic reaction and can be caused by foods, insect stings, medicines, or environmental factors; food being the most common for those under 18 (Pflipsen & Vega Colon, 2020). Approximately six million children in the U.S. have food allergies with 40% of these children having experienced a severe or anaphylactic reaction (Gregory, 2012). Anaphylaxis can happen to anyone at any time. It can be fatal if not treated. Food Allergy Research and Education (FARE) reports that food allergies are on the rise in the U.S. with a 50% increase in children between 2007 to 2021 and an increase in anaphylactic reactions of 377% between 2007 and 2016 (2024). This increase in reactions has resulted in an increase in anaphylactic reactions.  Pflipsen and Vega Colon (2020) report that 88% of children under 18 years old who experience an anaphylactic reaction experience difficulty breathing compared to 63 to 66% for their adult counterparts.

Numerous allergy, asthma, and immunology organizations endorse having epinephrine auto-injectors available in schools (Gregory, 2012). Early intramuscular injection of epinephrine is the first line treatment for an anaphylactic reaction; any delay in administration potentially meaning the difference between life and death (Pflipsen & Vega Colon, 2020 and FARE, 2024). The availability of epinephrine auto-injectors in schools, along with trained individuals, ensures the availability of life-saving medication when seconds count and any delay in treatment could permanently alter the outcome.

References

Food Allergy Research & Education (FARE). (2024). Facts and statistics. Retrieved from https://www.foodallergy.org/resources/facts-and-statistics

Gregory, N. L. (2012). The case for stock epinephrine in schools. NASN School Nurse (Print), 27(4), 222–225. https://doi.org/10.1177/1942602X12449057

Pflipsen MC, & Vega Colon KM. (2020). Anaphylaxis: Recognition and Management. American Family Physician, 102(6), 355–362

H.R. 2468 – 116^th Congress. (2019-2020). School-Based Allergies and Asthma Management Program (2021, Jan 5). Retrieved from https://www.congress.gov/bill/116th-congress/house-bill/2468

H.R. 4049 – 117^th Congress (2021-2022). Dillon’s Law. Retrieved from Retrieved from https://www.congress.gov/bill/117th-congress/house-bill/4049

H.R. 3910 – 118^th Congress (2023-2024). Dillon’s Law. Retrieved from https://www.congress.gov/bill/118th-congress/house-bill/3910

State of Florida (2024). Florida House of Representatives. HB 65. Retrieved from https://www.myfloridahouse.gov/Sections/Bills/bills.aspx

State of Florida (2021). The Florida Senate. HB 99 Use of epinephrine auto-injectors on public K-20 campuses. Retrieved from https://www.flsenate.gov/Session/Bill/2021/99/Analyses/h0099a.PEL.PDF

The PREVENT Pandemics Act: An Evidence-Based Approach to Health Policy

Recent Proposed Health Policy and Background

PREVENT Pandemics Act is a newly proposed health policy to fill the gaps in the United States and its response to the pandemic. This legislation was passed in 2022 and was designed by both parties because of the problems revealed by the COVID-19 crisis. The PREVENT Pandemics Act will help to increase the preparedness of the national public health system, improve the efficiency of cross-jurisdictional cooperation, and improve the country’s ability to respond to future pandemics effectively. According to the Office of Policy, Performance, and Evaluation (2019), health policies should be well-informed on the problem and its background; this Act is well-informed as far as the weaknesses of the pandemic are concerned.

Social Determinant Most Affecting the Policy

The PREVENT Pandemics Act primarily impacts healthcare access, a crucial social determinant of health. By enhancing healthcare availability and public health systems, this policy aims to improve patients’ access to appropriate care during emergencies. Sacristán and Dilla (2015) emphasize the importance of population- and patient-level data in healthcare decision-making. The Act does this by requiring changes in data and information systems in public health, which may enhance the availability of health care during pandemics. Such an emphasis on data modernization and information sharing is expected to improve the general readiness and preparedness of the healthcare system and, consequently, the patients and public health.

Evidence Base Supporting the Proposed Policy

The PREVENT Pandemics Act has much evidence in its favor. This focus on public health and integration makes it relevant to policy implementation research. Tummers and Bekkers (2014) note that policy enactment entails the organization’s capability and the official’s discretion, aspects captured by the Act to improve the country’s readiness to respond to health risks. The Act has been passed on data modernization and information sharing principles, supported by evidence indicating that integrated health data systems enhance decision-making and health. In enhancing these areas, the Act is well-positioned to greatly enhance the country’s capacity to effectively respond to future pandemics and other public health threats.

References

Office of Policy, Performance, and Evaluation. (2019). The CDC policy process. Centers for Disease Control and Prevention.https://www.cdc.gov/policy/polaris/policyprocess/index.html

Sacristán, J. A., & Dilla, T. (2015). No big data without small data: learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice,21(6), 1014–1017. https://doi.org/10.1111/jep.12350

Tummers, L., & Bekkers, V. (2014). Policy implementation, street-level bureaucracy, and the            importance of discretion. Public Management Review, 16(4), 527–547.             https://doi.org/10.1080/14719037.2013.841978

Health Policy

S.4918, a bill also known as the Safe and Affordable Drugs from Canada Act of 2024, aims to amend the Federal Food, Drug, and Cosmetic Act to allow for the personal importation of safe and affordable drugs from approved pharmacies in Canada. The bill proposes establishing a regulatory framework to ensure safety standards for imported prescription medications to ensure they meet US quality requirements. Prescription medications in this bill include medications purchased from an approved Canadian pharmacy, dispensed by a pharmacist licensed to practice pharmacy and dispense medications in Canada. These medications must be purchased for personal use, not resale, and filled with a valid prescription issued by a physician licensed in the US. The prescription medications must also have the same active ingredient(s), route of administration, dosage form, and strength as a prescription drug approved by the Secretary. It should be noted that this bill does not include a myriad of prescription medications, including controlled substances (United States Congress, 2024).

Background & Social Determinant of Health

The high cost of prescription medications in the US has long been a critical issue affecting millions of Americans. The United States spends more than $370 billion on prescription medications, and individuals spend more than $1,100 yearly on out-of-pocket healthcare costs, including prescription medications (Chalasani et al., 2022). With the cost of medications significantly higher in the United States, compared to other countries, many Americans face the financial strain of being able to afford essential prescriptions such as insulin or paying basic necessities such as rent and groceries. Those uninsured or underinsured Americans often face the biggest financial burdens to afford necessary prescriptions.

The economic stability or income determinant is most significantly affected by this policy. High prescription drug prices disproportionately impact low-income and underinsured populations, who often struggle with out-of-pocket costs for medications. The inability to pay for necessary medications results in non-adherence to treatment plans and worsening health outcomes, which can then lead to increased financial burdens.

Evidence to Support the Policy

Research has consistently shown that many prescription medications are priced lower in Canada due to government-imposed price controls. In 2020, the House Ways and Means Committee analysis found that, on average, US medication prices were on average nearly 2.5 times higher than in Canada. In some instances, the medications were up to 10 times higher. At the state level, the US already has some experience with importing medications. For example, Colorado and Florida have introduced programs to import medications from Canada under the Federal Food, Drug, and Cosmetic Act. These programs lay the groundwork for larger-scale implementation. Polls of Americans have shown widespread support for lowering the cost of prescription medications and allowing the purchase and importation of medications from Canada.

By leveraging current and existing evidence on medication pricing, public sentiment, and safety protocols, S.4918, the Safe and Affordable Drugs from Canada Act of 2024, aims to address a critical health and economic challenge facing the US population and healthcare system.

References

United States Congress. (2024, July 31). S.4918- Safe and Affordable Drugs from Canada Act of 2024. Retrieved October 7, 2024, from https://www.congress.gov/bill/118th-congress/senate-bill/4918/text?s=1&r=71

Chalasani, R., Krishnamurthy, S., Suda, K. J., Newman, T. V., Delaney, S. W., & Essien, U. R. (2022). Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress. Journal of Health Politics, Policy & Law, 47(6), 709–729. https://doi.org/10.1215/03616878-10041135

Dusetzina, S. B., Besaw, R. J., Whitmore, C. C., Mattingly II, T. J., Sinaiko, A. D., Keating, N. L., & Everson, J. (2023). Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022. JAMA Network Open, 6(5), e2314211. https://doi.org/10.1001/jamanetworkopen.2023.14211

Hong Y, Hincapie-Castillo JM, Xie Z, Segal R, Mainous AG. Socioeconomic and Demographic Characteristics of US Adults Who Purchase Prescription Drugs From Other Countries. JAMA Netw Open. 2020;3(6):e208968. doi:10.1001/jamanetworkopen.2020.8968

Sachs, R. E., & Bagley, N. (2020). Importing Prescription Drugs from Canada – Legal and Practical Problems with the Trump Administration’s Proposal. New England Journal of Medicine, 382(19), 1777–1779. https://doi.org/10.1056/NEJMp2000464

Health policy H.R. 5975, “Keeping Drugs Out of Schools Act of 2023”

Governments and health organizations have launched public health campaigns to educate the public about the risks of substance abuse and the availability of treatment options. These campaigns often target specific populations, such as youth or pregnant women, to prevent substance use and promote healthy behaviors. Health policy H.R. 5975, “Keeping Drugs Out of Schools Act of 2023,” allows the Office of National Drug Control Policy to award grants for eligible entities to implement school-community partnerships for preventing and reducing substance use and misuse among youth (Congress.gov n.d.). It will establish a comprehensive plan for the school community consisting of primary through high school levels through partnership and to implement effective drug prevention programs.

Background on Substance Misuse

Substance misuse is a huge issue impacting millions of individuals globally. The use of drugs, alcohol, or other hazardous substances, including tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects that may result in addiction, health issues, social and economic obligations, or even death is referred to as substance abuse by the CDC. In the last five years, several health policies regarding substance abuse have been proposed and implemented, reflecting a growing recognition of the need for comprehensive approaches to address this issue. Governments and health organizations have launched public health campaigns to educate the public about the risks of substance abuse and the availability of treatment options. These campaigns often target specific populations, such as youth or pregnant women, to prevent substance use and promote healthy behaviors. Approximately 35,000 young children are brought to the emergency room each year because they got into medicines that were left within reach (Budnitz et al., 2023).

Social Determinants

The social determinant that most affects substance abuse policies is socioeconomic status. This includes factors such as income, education, and employment, which influence access to healthcare, treatment options, and support services. Individuals with lower socioeconomic status often face barriers to accessing quality care and may live in environments with higher exposure to substance use. Addressing these disparities is crucial for effective policy implementation and ensuring equitable access to prevention and treatment services. This policy addresses the critical healthcare issue of substance use and misuse in our youth by funding educational needs too all school aged children and promotes prevention. This bill aims to reduce financial barriers, ensuring that all children, regardless of parental income, receive the necessary education for prevention and care.

Evidence-Based Research

In response to the opioid crisis the United States, has introduced policies aimed at combating the opioid crisis. These include increasing access to naloxone, expanding treatment options such as medication-assisted treatment (MAT), and implementing prescription drug monitoring programs to prevent over-prescription. Over time, we have seen an increased reliance on data to drive decisions in the nation’s healthcare system (Short, 2022). Research has improved our understanding of factors that help buffer youth from a variety of risky behaviors, including substance use. A robust amount of evidence base information from a combination of research studies, pilot program results, expert consensus, statistical data, comparative analysis, and cost-benefit evaluations, are reasons I support the proposed policy. These elements have indicated positive outcomes. For example, the decline in ED visits for medication exposures among young children from 2009-2020 is consistent with reported declines in calls to US poison centers for medication exposures among young children over the same period(). Some of the largest declines in visits for prescription solid exposures involved medication classes for which there have been interventions to reduce overdose among adults and adolescents (e.g., opioids, benzodiazepines) by reducing the amount of these products available through judicious prescribing, use of alternate therapies, take-back programs, and education (Budnitz et al., 2023).

Conclusion

Drug addiction is a serious issue that calls for a multifaceted strategy that includes not just treatment but also prevention and changes in legislation. This policy reflects a shift towards treating substance abuse as a public health issue rather than solely a criminal justice problem, emphasizing prevention through education support. Boosting financing for harm reduction initiatives and programs that educate against and prevent drug dependence. With the use of education and awareness campaigns, supportive surroundings, and the implementation of anti-abuse laws, prevention programs try to stop drug addiction before it ever occurs.

References

843. S., Geller, A. I., Goring, S. K., Lind, J. N., Lovegrove, M. C., Rose, K. O., & Weidle, N. J. (2023). Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures. American journal of preventive medicine, 64(6), 834–843. https://doi.org/10.1016/j.amepre.2023.01.011

Congress.govLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Elliott, K. R., Jones, E.. (April 1, 2019). The association between frequency of opioid misuse and opioid use disorder among youth and adults in the United States, Drug and Alcohol Dependence, 197, 73-77. https://doi.org/10.1016/j.drugalcdep.2019.01.008

National Center for Health Statistics. (). Substance Use. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/hus/sources-definitions/substance-use.htm#:~:text=Substance%20use-,Substance%20use,dependence%20and%20other%20detrimental%20effects.

Short, N. (2022). Milstead’s health policy and politics: A nurse’s guide (7^th ed.). Jones & Bartlett Learning.

The Protecting Health Care for All Patients Act of 2023 (S.1113) seeks to prohibit the use of quality-adjusted life year measures in federal health programs. The quality- adjusted life year is used in some health policies to evaluate the cost-effectiveness of medical treatments by quantifying the number of additional years a treatment provides while accounting for the quality of those years. However, this method has raised concerns about discrimination, especially against individuals with disabilities, older adults, or those with chronic illnesses. The bill aims to ensure that health care decisions do not devalue the lives of patients based on perceived quality or length of life.

The issue addressed by this bill stems from ethical concerns about how health care resources are allocated, particularly in cost-effectiveness analyses. The use of quality-adjusted life year in healthcare decisions could result in treatments being denied or devalued for people whose life expectancy or quality of life may not meet certain thresholds. Critics argue that this method risks prioritizing treatments for those deemed “healthier, “ which can deepen inequities in care access, especially for vulnerable populations.

The social determinant of health most affected by this policy is health care access and quality. The use of QALY in decision making could systemically reduce access to care for populations who are already marginalized, such as people with disabilities or chronic conditions, who may be viewed as benefiting less from treatments. If the policy is passed, it could reduce disparities in access to health care and ensure that all patients, regardless of their condition, receive equal consideration.

There is substantial evidence to support the concerns raised by the policy. Studies have shown that reliance on QALY-based assessments can lead to biases against patients with disabilities or chronic diseases. For example, a 2019 analysis published in the Health Affairs Journal highlighted how QALY-based evaluations often underestimate the value of life-extending treatments for patients with lower perceived quality of life. In response to such evidence, several advocacy groups, including disability rights organizations, have lobbied for policy changes to prevent QALY’s use in decision-making, which strengthens the case for this bill. By removing QALY from health policy decisions, the proposed legislation aligns with a growing body of evidence advocating for more equitable approaches to healthcare resource allocation. The policy’s goal of ensuring non-discrimination in healthcare access would likely result in broader protections for vulnerable groups.

References

H.R.485 – Protecting Health Care for All Patients Act of 2023. (n.d.). Retrieved October 9, 2024, from https://www.congress.gov/bill/118th-congress/house-bill/485

Stanford, F. C. (2020). The Importance of Diversity and Inclusion in the Healthcare Workforce. Journal of the National Medical Association, 112(3), 247–249. https://doi.org/10.1016/j.jnma.2020.03.014

The CDC Policy Process | POLARIS | Policy, Performance, and Evaluation | CDC. (n.d.). https://www.cdc.gov/policy/polaris/policyprocess/index.html

The Support for Patients and Communities Reauthorization Act (H.R. 4531) aims to extend and enhance federal efforts to address the opioid crisis by improving access to treatment and recovery services and refining opioid prescription guidelines. The bill is in response to the continued devastation caused by opioid misuse across communities, necessitating sustained support for effective interventions. It encompasses provisions to bolster healthcare service access and community recovery initiatives, reflecting a comprehensive approach to curbing opioid abuse and its far-reaching consequences (Congress.gov, 2023; GovTrack.us, 2023).

The social determinant of health most impacting this policy is economic stability, particularly access to sufficient income and resources to cover living essentials and healthcare. Economic barriers significantly affect treatment access, with lower income and education levels correlating with reduced healthcare accessibility, including vital addiction treatment and recovery services (Whitman et al., 2022). This bill, by addressing these disparities, aims not only to support recovery but also to prevent addiction onset among vulnerable populations. The evidence supporting this policy is robust, emphasizing the crucial role of comprehensive healthcare access and social support systems in combating the opioid epidemic, showcasing effective strategies through previously implemented programs (Loaiza & Rebola, 2022). 2022). This reauthorization act leverages past successes and lessons to enhance and sustain critical interventions, demonstrating a well-founded strategy based on empirical evidence and targeted social determinants.

References

Congress.gov. (2023, December 13). H.R.4531 – Support for Patients and Communities Reauthorization Act. https://www.congress.gov/bill/118th-congress/house-bill/4531?q=%7B%22search%22%3A%22Support+for+Patients+and+Communities+Reauthorization+Act%22%7D&s=4&r=1 

GovTrack.us. (2023, December 12). H.R. 4531: Support for Patients and Communities Reauthorization Act. https://www.govtrack.us/congress/votes/118-2023/h715 

Loaiza, S. R., & Rebola, C. B. (2022). Fighting the opioid crisis by design: Technology solutions as innovative systems for advancing communities of care against overdose deaths. DISCERN: International Journal of Design for Social Change, Sustainable Innovation and Entrepreneurship, 3(2), 97-107. https://designforsocialchange.org/journal/index.php/DISCERN-J/article/view/95

Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., & Sommers, B. D. (2022). Addressing social determinants of health: Examples of successful evidence-based strategies and current federal efforts. Off Heal Policy, 1, 1-30. https://www.aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf

Week 7 Discussion Post:

This week, we are analyzing a recent healthcare policy change and its effects. I have chosen the Lower Costs, More Transparency Act (H.R. 5378) of 2023. This legislative action includes measures to promote cost transparency requirements for hospitals and extends these rules into other patient care areas. This bill has been passed to reduce the amount of hidden or excessive costs in healthcare as well as health insurance situations. Hospitals and insurance companies could hide the amount of money they were charging for a particular good or service and pass that sometimes excessive “cost” on to patients.

The number one social determinant that would affect this bill would be economic status and stability. This bill would have a greater impact on those who struggle to pay medical bills or are forced to set up payment plans for medical bills. This is because the bill enforces regulations regarding payment plan billing in hopes of reducing the cost to patients. This is done by requiring PBMs and employer-sponsored health plans to perform audits of cost information.

We have to look at the research to determine whether or not this bill will be effective in combating rising healthcare costs to consumers. The data on the effects of promoting cost transparency is conflicted. Some research states that there needs to be more quantitative data to prove a meaningful correlation between improving cost transparency and market efficiency (Joosse et al., 2022). On the other hand, in healthcare-oriented studies, cost transparency has been established as a valuable tool for improving patient costs (Yong et al., 2010). This is likely due to the fact that healthcare is an unavoidable cost to many individuals, so they cannot choose to spend their money elsewhere. For this bill, requiring cost transparency in healthcare will make a positive impact in combating the crisis of rising healthcare costs, and there is enough evidence in the research available to support it.

H.R.5378 – 118th Congress (2023-2024): Lower Costs, More Transparency Act. (2023, December 11). https://www.congress.gov/bill/118th-congress/house-bill/5378

Joosse, I. R., Tordrup, D., Glanville, J., Kotas, E., Mantel-Teeuwisse, A. K., & Van Den Ham, H. A. (2022). Evidence on the effectiveness of policies promoting price transparency – A systematic review. Health Policy, 134, 104681. https://doi.org/10.1016/j.healthpol.2022.11.002

Yong, P. L., Saunders, R. S., & Olsen, L. (2010). Transparency of cost and performance. The Healthcare Imperative – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK53921/#:~:text=Transparency%E2%80%94of%20the%20costs%2C%20prices,et%20al.%2C%202007).

Telehealth or Telemedicine Services

Obtaining healthcare can be difficult for individuals; this was proven during the COVID-19 pandemic. Since then, lawmakers and providers have been on a mission to come up with a solution for those who need healthcare but don’t always have access. For my healthcare policy, I have decided to do further research into telehealth services. “Telemedicine refers to the provision of healthcare services remotely through the use of telecommunications and information technology. This can include video consultations, remote monitoring, and electronic transmission of medical records. The significance of telemedicine lies in its ability to bridge geographical barriers, improve patient access to healthcare, and enhance the efficiency of healthcare delivery systems. By enabling healthcare professionals to diagnose, treat, and monitor patients from a distance, telemedicine can revolutionize how healthcare is delivered, particularly in areas with limited access to medical facilities.” (Anawade et al., 2024)

The bill I chose to look at is H.R.4189, which helps expand telehealth services under Medicare. Telehealth has not always been widely accepted by insurance companies, but this expansion will help justify the need for services in all areas, especially those that are more remote. According to this bill, 91% of the patients who utilized telehealth were satisfied with the services they used. They looked back after the pandemic and realized that approximately 0.1% of Medicare users had done some sort of telehealth service.  I have seen a lot of telehealth services in urgent care and primary care settings. These have since helped patients who are unable to get out of their homes because of their physical limitations still receive proper healthcare. On top of some people not having the ability to get into an office to see a provider, we have a shortage of nursing staff. Telehealth providers don’t require a nurse to take care of these patients unless the nurse is specifically in a telehealth position.

This bill started with expanding geographic requirements which means that there doesn’t have to be a set location for the home of patients. Home could mean any place they can access the internet and a computer. They also want to implement that the cost associated with services will be costs that insurance will cover like a normal visit, in-person would be. If this bill is passed, it will expand many avenues for patients utilizing telehealth, with all the above and other services including hospice. We need to be more willing to talk about telehealth because our hospitals are being overrun with patients and we are constantly losing more nursing staff. Telehealth in some areas.

As an ED nurse, I see patients multiple times per shift who were sent from their primary care because they were unable to be seen in the office. Patients utilize the Emergency Department as a primary care and urgent care source because there are few options. After all, primary care is full. Although not all patients would benefit from telehealth services, a good majority could cut their costs by switching from the ED to a telehealth service. There is a trend in the United States where online programming is taking over in-person meetings. This would help those who have a fear of hospitals and allow them to see providers where they are comfortable.

References:

Anawade, P. A., Sharma, D., & Gahane, S. (2024). A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus, 16(3), e55996. https://doi.org/10.7759/cureus.55996

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors international, 2, 100117. https://doi.org/10.1016/j.sintl.2021.100117

H.R.4189 – CONNECT for Health Act of 2023. (2023, June 16). Congress.Gov. https://www.congress.gov/bill/118th-congress/house-bill/4189/text?s=2&r=9&q=%7B%22search%22%3A%22telehealth+policy%22%7D

PROPOSED HEALTH POLICY

Health insurance coverage

A health proposed policy I have chosen is the American health insurance system. It discusses President Trump’s suggestions to reevaluate and replace the Affordable Care Act and the proposed Marketing and Outreach Restoration to Empower Health Education Act of 2019. The act would require the Health and Human Services Department to conduct educational outreach regarding centrally facilitated health insurance exchanges, focusing on educating individuals about the availability of insurance coverage and associated financial assistance.

Background and Social Determinant

The Trump Administration has cut funding that encourages people to sign up for plans on the federal marketplaces, potentially undermining the Affordable Care Act.” (Mena Report 2019). It’s important to note that slightly less than half of Americans receive coverage through their employers or a family member’s employer. Furthermore, 17% of the population is covered by Medicare, a program designed to provide health insurance for seniors and specific individuals with disabilities. (2019). Another 17% of Americans receive health coverage through Medicaid, a joint federal and state program offering low-income individuals’ insurance. In addition, about 5% of the population purchases their health insurance on the individual market, either through the marketplaces established by the Affordable Care Act (ACA) or directly from various insurance companies. However, it is concerning that approximately 9% of citizens, roughly 30 million individuals, still lack health insurance. Recognizing that the number of uninsured Americans has decreased since the ACA was implemented is essential. This is mainly due to expanding Medicaid to cover more low-income individuals and providing financial assistance for many individuals who purchase coverage on the individual market. “Some social determinants of healthcare insurance include income, employment status, education, and access to resources and support networks.”( Hoagland A. 2024).  These factors can all influence an individual’s ability to obtain and maintain healthcare insurance.

Intentions of the policy

The policy aims to replace ACA sections by offering financial aid for personal market coverage and Medicaid funds for cities with donations that provide less funding. It also seeks to eliminate policies hindering insurers from covering pre-existing conditions and specific services.

Evidence base to support the proposed policy

The primary focus of any Medicare system should be maximizing its value. Every individual within the system should be motivated to assess and enhance its value. “The widespread availability of substandard insurance plans presents a significant issue, enabling insurance companies to target healthy individuals exclusively. Consequently, this results in a pool of insured individuals who are generally less healthy. While a select few may benefit from reduced costs, most will experience increased financial burdens” (States News 2019). Effectively evaluating the system’s worth is crucial for improving healthcare provision, and therefore, effective strategies need to be developed to overcome the associated challenges.  “A study has revealed that the combination of these substandard plans, the absence of mandates, and other efforts to undermine the Affordable Care Act could increase thousands of dollars in costs for everyone else” (States News 2019). Some examples of effective strategies to develop and improve the Medicare system to maximize the value it provides could include:

1. Implementing preventive care programs to reduce costly health issues.
2. Promoting technology to streamline administrative processes and enhance patient care.
3. Encouraging collaboration between healthcare providers to ensure comprehensive and coordinated patient care.
4. Fostering transparency in pricing and quality of care to empower patients to make informed decisions.
5. Investing in research and innovation to continually improve treatment options and healthcare outcomes.
6. Providing incentives for healthcare providers to deliver high-quality, cost-effective care.
7. Educating patients about their healthcare options and empowering them to participate in their care actively.

References

MARKETING AND OUTREACH RESTORATION TO EMPOWER HEALTH EDUCATION ACT OF 2019. (May 16, 2019). States News Service. https://link.gale.com/apps/doc/A593599628/EAIM?u=minn4020&sid=ebsco&xid=8595dcee

United States : As Trump Administrations Sabotage Contributes to Decline in Health Care Coverage, Shaheen Moves to Protect Funding for Open Enrollment Awareness and Assistance. (2019, February 16). Mena Report. https://link.gale.com/apps/doc/A574359957/EAIM?u=minn4020&sid=ebsco&xid=c5744e78

Centers for Medicare & Medicaid Services. In-person assistance in the health insurance marketplaces. 2019. Accessed June 29, 2022. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/assistance

Hoagland A, Yu O, Horný M. Social Determinants of Health and Insurance Claim Denials for Preventive Care. JAMA Netw Open. 2024;7(9):e2433316. doi:10.1001/jamanetworkopen.2024.33316

MAIN POST

Analysis of the Equitable Health Care for All Act (H.R.5742)

In this discussion, I will examine the “Equitable Health Care for All Act” (H.R.5742), a significant legislative proposal introduced during the 117th Congress (2021-2022) aimed at addressing healthcare disparities through enhanced data collection and reporting requirements. This act underscores the commitment to eliminating explicit and implicit biases in healthcare delivery, which have historically led to inferior care outcomes for individuals based on race, nationality, sex, disability, age, or religion (H.R.5742 – 117th Congress (2021-2022): Equitable Health Care for All Act, 2021).

Background and Development

The impetus for H.R.5742 stems from longstanding evidence indicating that health disparities are a pervasive issue within the U.S. healthcare system. The Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care’s landmark report “Unequal Treatment” (2003) revealed that racial and ethnic minorities typically receive lower-quality healthcare compared to their white counterparts, even when factors such as insurance status, income, age, and the severity of conditions are comparable (Institute of Medicine, 2003).

Comparative Analysis with Other Policies

Comparing H.R.5742 to prior initiatives, such as the Affordable Care Act, highlights both advancements and existing gaps. This bill introduces more stringent requirements for data transparency and aims to enforce accountability more rigorously, suggesting a progression from previous policies which also sought to address these disparities (Sacristán & Dilla, 2015).

Social Determinant Most Affected

The social determinant of health most influenced by this policy is race and ethnicity. H.R.5742 directly targets the disparities in health outcomes related to these factors, seeking to establish a more equitable healthcare system through improved data transparency and accountability.

Broader Contextualization Within Health Policy Frameworks

The success of this policy could hinge on its compatibility with existing healthcare practices and workflows. Klein and Sorra (1996) highlight that the successful implementation of innovations in healthcare settings often depends on aligning new practices with existing values and workflows, which could be a pivotal factor for the enactment of H.R.5742.

Evidence Base Supporting the Proposed Policy

The evidence base for H.R.5742 is robust, drawing on decades of research that document disparities in healthcare. The policy aims to facilitate the identification and rectification of inequities in healthcare service provision by mandating that healthcare providers and facilities report disaggregated data.  This approach aligns with evidence-based practices advocated in health policy literature, emphasizing the importance of data in informing health policy decision-making (Sacristán & Dilla, 2015).

The implementation of such policies has been supported by academic research, which suggests that actionable data is crucial for effective health intervention strategies (Klein & Sorra, 1996). The frameworks like those discussed by Tummers and Bekkers (2014) indicate the critical role of policy implementation in ensuring the success of initiatives intended to manage public health challenges, particularly those as complex as healthcare disparities.

Potential Challenges and Mitigation Strategies

Implementation could face challenges such as resistance from healthcare providers due to the increased burden of reporting requirements and potential political hurdles. Proactively engaging with stakeholders and continuous policy evaluation could help overcome these barriers and ensure the policy meets its objectives (Tummers & Bekkers, 2014).

Conclusion

The “Equitable Health Care for All Act” is a forward-thinking proposal that not only addresses the symptoms of healthcare inequities but also tackles the underlying causes through systematic changes in data handling and policy enforcement. The legislation’s focus on evidence-based interventions and its reliance on empirical data make it a compelling example of how policy can be used to effect meaningful improvements in public health.

References

H.R.5742 – 117th Congress (2021-2022): Equitable Health Care for All Act. (2021). Congress.gov. https://www.congress.gov/bill/117th-congress/house-bill/5742

Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press (US).

Sacristán, J. A., & Dilla, T. (2015). No big data without small data: learning health care systems begin and end with the individual patient. Journal of evaluation in clinical practice, 21(6), 1014–1017. https://doi.org/10.1111/jep.12350

Klein, K. J., & Sorra, J. S.(1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1080.

Tummers, L., & Bekkers, V. (2014). Policy implementation, street-level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527–547.

https://pure.eur.nl/ws/files/47487119/Metis_189879.pdf

BreAnn Norris

Discussion Main Post

Health Policy

End of life care is a sensitive and important part of healthcare that is headed in the right direction but can use some work. Most clinicians understand the importance of respecting the patient’s wishes; however, most families do not abide by this. With a background in critical care, unfortunately I have seen numerous examples of the patient’s wishes not being respected. When researching currently proposed health related policy, I came across the Compassionate Care Act, proposed by Representative Nanette Diaz Barragan. Respecting patient’s end of life decisions should be at the forefront of our minds in healthcare. The main goal of the Compassionate Care Act is ultimately “to improve end-of-life care” (Compassionate Care Act, 2024). This policy contains multiple sections to include planning for end-of-life care, education to the healthcare provider regarding the rights of the patient pertaining to end-of-life care, and research directed at creating a singular advanced directive that is accepted by all. This Act stresses the importance of including the patient and interdisciplinary team, frequent alterations as needed, and allowing the patient to create a plan tailored to them.

Background & SDOH

I believe that the many social determinants of health apply to this policy topic; however, education is the most influential social determinant of health. “Low education level is associated with low health literacy” (Irvin, S., McGowan, M., & Zavala, A., 2020). Numerous patients and families are unaware of the advanced directive or other form of document for end-of-life wishes. The lack of knowledge or access to this information leads to no document at all which places the family under tremendous stress when attempting to act in the best interest of the patient. There is another side to this being the family understandably does not want the resuscitative efforts to cease; however, this may yield more harm than good. I believe that by simply increasing knowledge on this topic, a great deal of patient and family grief can be avoided.

Evidence

“The attainment of patients’ treatment preferences is key to quality patient-centered end of life care” (Bar-Sela, G., Tur-Sinai, A., Givon-Schaham, N., & Bentur, N., 2023). As evidenced by the previous statement while conducting peer-reviewed research, I do believe that there is evidence to support this policy. Voicing wishes on end-of-life care has been an ongoing task; however, this is not well understood and requires more research and policy to assist the population in the importance and access to such documentation. This policy will help the population by bringing knowledge and education to not only the patients but also to the healthcare staff.

References

Bar-Sela, G., Tur-Sinai, A., Givon-Schaham, N., & Bentur, N. (2023). Advance care planning and attainment of cancer patients’ end-of-life preferences: relatives’ perspective. American Journal of Hospice & Palliative Medicine, 40(3), pp. 322-328. http://dx.doi.org/10.1177/10499091221099921

Compassionate Care Act, H.R. 9237, 118th Cong. (2024). https://www.congress.gov/bill/118th-congress/house-bill/9237/text?s=2&r=25

Irvin, S., McGowan, M., & Zavala, A. (2020). Advance care planning and advance directives completion of elderly patients at a rural health clinic on a regional medical campus. Journal of Regional Medical Campuses, 3(2). https://doi.org/10.24926/jrmc.v3i2.2221

Health Policy H. Res 1242 – Prioritizing mental health to the same degree as physical health to address the epidemics of suicide and drug overdose in the United States

Mental health is a growing concern finally reaching Washington D.C. This policy states that mental health should be just as important as physical health. It also states that insurance should cover mental and physical health equally, we should extinguish stigma, support the 2024 National Strategy for Suicide Prevention, and seek funding to assist in these efforts. (Congress.gov, 2024). Other efforts include supporting access and coverage of medication-assisted treatment, adopting evidence-based suicide prevention strategies, funding culturally, linguistically, and age-appropriate services, improving quality, coverage, and accessibility of crisis care services, and utilizing health promotion campaigns to target young adults and adolescents. (Congress.gov, 2024). If these efforts are placed into motion, this could cause a turnaround in the nation’s mental health which could lead to a positive change.

Social Determinant that affects this Health Policy

A critical social determinant in mental health appears to be lower income. It affects individuals in several ways. According to Alegria et. al., throughout many countries, including the U.S., lower income is linked to self-harm, suicide attempts, depression, and anxiety among many different people (2018). This is based on a lack of income needed to meet one’s basic needs which leads to poor outcomes. Lack of income can affect housing and housing conditions, transportation, and food sources (Alegria et. al., 2018).  Lack of income can also affect access to mental health and substance use resources.

Evidence Base to Support this Health Policy

Many data support this health policy. The rate of suicide in America has become increasingly distressing. According to the Centers for Disease Control and Prevention (CDC), 49,000 people died by suicide in 2022 which is one person every 11 minutes. (2024). Overdoses also continue to be a problem. In 2022, 107,941 drug overdoses occurred which is a rate of 32.6 deaths per 100,000 standard population. (CDC, 2024). There is also a correlation between mental health and substance use disorder. “According to the National Alliance on Mental Illness, 33.5 percent of United States adults with mental illness also experienced a substance use disorder in 2021, which is over 19,400,000 individuals.” (Congress.gov, 2024) This is an alarming rate. “According to a 2022 literature review of 38 studies on mental health and opioid overdose, nearly all reviewed studies found a connection between mental disorder and overdose.” (Congress.gov, 2024). These diseases go hand in hand. There have been enough studies to show that this proposed policy deserves the government’s attention. If we do not begin addressing these issues, the numbers will only continue to rise. The time is now to make the change.

Resources

Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y., & Alvarez, K. (2018). Social Determinants of Mental Health: Where we are and where we need to go. Current Psychiatry Reports, 20(11). https://doi.org/10.1007/s11920-018-0969-9

Centers for Disease Control and Prevention. (2024a, March 21). Products – data briefs – number 491 – March 2024. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db491.htm#:~:text=The%20overall%20rate%20of%20drug%20overdose%20deaths%20remained,32.6%20deaths%20per%20100%2C000%20standard%20population%20%28Figure%201%29.

Centers for Disease Control and Prevention. (2024b, July 18). Suicide data and statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/suicide/facts/data.html#:~:text=Over%2049,000%20people%20died%20by%20suicide%20in%202022.%201%20death

H.Res.1242 – 118th Congress (2023-2024): Prioritizing Mental Health to the same degree as physical health to address the epidemics of suicide and drug overdose in the United States. | Congress.gov | Library of Congress. Congress.gov. (2024, May 17). https://www.congress.gov/bill/118th-congress/house-resolution/1242

Initial Response- The Protecting Health Care for All Patients Act of 2023 (H.R.485)

The Protecting Health Care for All Patients Act of 2023 (H.R.485), introduced in Congress, seeks to prohibit the use of “quality-adjusted life years” (QALYs) in federal healthcare programs for determining the cost-effectiveness of treatments. This policy responds to ethical concerns that QALYs assign lower value to the lives of individuals with disabilities or chronic conditions, potentially restricting their access to necessary medical treatments. By removing QALYs from healthcare decision-making, the policy aims to create a more inclusive and equitable healthcare system, ensuring that all patients, regardless of their health status, are treated equally when it comes to accessing care (Congress.gov, 2023).

One of the most significant social determinants of health affecting this policy is economic stability. The use of QALYs in cost-benefit analyses often results in reduced access to expensive, life-saving treatments for individuals with chronic illnesses or disabilities. The economic burden disproportionately affects already vulnerable populations, exacerbating existing health disparities. By eliminating QALYs as a basis for healthcare decisions, this bill seeks to prevent financial considerations from unduly limiting access to care, thereby promoting health equity.

In my opinion, there is a strong evidence base supporting this policy. Studies have consistently shown that QALYs can lead to discriminatory practices, particularly against people with disabilities, as they often undervalue the quality of life for these individuals. For example, QALYs might make certain treatments appear less cost-effective simply because they are used for patients with chronic conditions or disabilities, which could lead to restricted access (Milstead, 2022). The bill promotes equity in healthcare decision-making by removing this biased model, allowing all patients to be treated with dignity. Research supporting the elimination of QALYs also emphasizes alternative approaches, such as patient-reported outcomes, which could provide a more comprehensive and equitable way to assess treatment value. This evidence demonstrates the need for reform to ensure that healthcare decisions reflect the needs of all individuals, particularly those who are most vulnerable to systemic inequities (Sacristán & Dilla, 2015).

References

Congress.gov. (2023). H.R.485 – Protecting Health Care for All Patients Act of 2023. Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/485

Milstead, J. A. (2022). Health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Sacristán, J. A., & Dilla, T. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017.

H.R 1638 Improving Access to Mental Health Act

I’ve selected mental health improvement policy H.R. 1638 Improving Access to Mental Health Act of 2023 (H.R.2023). This bill is involving in creating, implementing strategies to enhance the accessibility and the quality of mental health services. This improvement on these policies is addressing a range of issues, performing assessment, diagnosing for the treatment of mental illness. This bill increases Medicare reimbursement rate, but also excluding the payments for mental health services rendered in inpatient and skills nursing facilities participating in the Medicare program. An effective policy that will support mental health condition, integrate mental health care into general healthcare. Encouraging collaboration between governmental agencies, healthcare providers, and communities to create a comprehensive mental health system to support the vulnerable population. Mental health issue is a global concern. According to the WHO one in eight people worldwide live with a mental disorder. Mental health services are often underfunded, many other barriers, lack of insurance coverage, not enough provider in the network, disparities in care, and longer wait time for treatment. Addressing these challenges requires a robust policy reform in which funding need to be increased, an inclusive and more holistic approach to mental health

S.3847 Improving ow socioeconomic Social Determinant of health Act of 2024

Socioeconomic Status (SES) is one of the most significant social determinants that affect mental health policy. In which employment, encompasses income, education profoundly impact mental health in several ways like; access to care because of low socioeconomic status, no access to mental health services, lack of health insurance. Poor living conditions, overcrowded, unsafe environments, and food insecurity that will increase stress and the risk for mental illness. Lower-level of education which reduces awareness and the ability to detect or advocate for oneself. Unstable employment that will lead to chronic stress, depression, anxiety, and no healthcare benefits. Social exclusion and discrimination that will exacerbate mental illness and create additional barriers to receive proper treatment. Effective mental health policy must address these issues to reduce the impact of stressors related to poverty and provide comprehensive support across the communities.

Evidence Base to Support Proposed Policy

Evidence-based approach is essential to ensure that that the reforms are sustainable and effective. Research to show early intervention/prevention for mental health. School’s programs, long-term economic benefits, reduced meals, and reduce healthcare costs. Evidence of integration of mental health services into primary care for underserved populations. Example: to improve access to psych therapy program in the UK provides mental health care in primary settings to reduce wait time for treatment and improve recovery wait. Collaborative care models, primary care working alongside with mental health professionals shown improve outcomes for mental disorder patients. Investing in mental health services that will lead to an excellent economic benefit. Bring in policies that focus on reducing stigma through public campaigns on mental health educations to successfully change public perceptions, increase awareness, and accessing mental health services. MHA dedicates this report to mental health advocates who fight tirelessly to help expand access to care and reduce disparities and inequities for people with mental health concerns.

Conclusion

Evidence-based findings strongly support policies that promote early intervention, provide adequate funding, reducing stigma, and enforce parity in mental health coverage. That will ensure better healthcare access services, improve outcomes and economic benefits for society.

References

Text – S.3847 – 118th Congress (2023-2024): Improving Social Determinants of Health Act of 2024 | Congress.gov | Library of Congress

Br J Psychiatry. 2015 Nov;207(5):377-84. doi: 10.1192/bjp.bp.114.151944.PMID: 26527664

Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in    the rural USA. Public Health, 129(6), 611–620. doi: 10.1016/j.puhe.2015.04.001

Reinert, M, Fritze, D. & Nguyen, T. (October 2022). “The State of Mental Health in America 2023” Mental Health America, Alexandria VA.

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