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Health equity is the foundation of patient safety, quality of care, and improved health outcomes for vulnerable populations. A Triple Aim is an approach for optimizing the performance of healthcare systems offered by the Institute for Healthcare Improvement (IHI). The initiative was developed to enhance the patient experience, improve the health of populations, and reduce healthcare costs. (Institute for Healthcare Improvement, 2018). The Affordable Care Act (ACA) successfully addresses financial issues via cost-effective mechanisms of government spending cuts and taxation. The policy aims at improving health equity for populations via value-based insurance coverage and deals with the problem of affordable quality care for patients with preexisting conditions and previously uninsured individuals. The goals of safety, quality, and improved outcomes for all individuals are explicitly described in the policy, as its 2016 rule was issued to enhance the understanding of the needs of minority and LGBTQ patients.
The ACA promoted multiple measures to provide safety and quality of healthcare for vulnerable, medically underserved populations, or low-income populations via affordable insurance coverage. For example, the policy improved health outcomes for LGBTQ patients by decreasing the number of uninsured LGBTQ individuals and providing them with access to safe and quality healthcare. However, the main problem that undermines the effectiveness of the ACA is the lack of financial support and the introduction of penalties for safety-net providers. Despite the ACA efforts, millions of vulnerable Americans cannot afford healthcare insurance, so they have to rely on safety-net hospitals managing the populations with a significant risk of poor health outcomes. For instance, low-income individuals without insurance do not receive Medicaid coverage in 19 states (Shin & Regenstein, 2016). The introduction of the Hospital Readmission Reduction Programme (HRRP) and the Hospital Value-Based Purchasing (HVBP) resulted in penalties for safety-net providers despite their success in the prevention of 30-day mortality (Gaffney & McCormick, 2017). Therefore, while the ACA increased the number of insured LGBTQ adults, it negatively affected the access to safe and quality care for uninsured and vulnerable populations.
The implementation of the ACA impacted the nursing practice by expanding the responsibilities of healthcare professionals. Namely, the pay-for-value approach of the ACA urged hospitals to depend on the nurses competency, patient-focused practice, and communication to support other healthcare professionals (Mason et al., 2021). According to Standard 14 by the American Nurses Association (2015), the registered nurse should provide safe, effective, and patient-centered care, recommend improvement strategies, monitor the quality of care, and participate in interprofessional teams. The changes introduced by the policy allowed the nurses, who traditionally play a crucial role as care providers, to have opportunities for decision-making and evaluation of safety and quality of care (Stimpfel et al., 2019). Additionally, the policy recommends care providers, including nurses, consider the needs of LGBTQ patients but does not require them to treat diverse patients with respect or avoid judgmental attitudes.
My position is that the ACA is a positive contribution to US healthcare, but it should be amended as it ignores the needs of uninsured or low-income populations who rely heavily on safety-net hospitals. Based on the assessment of the ACA, it might be concluded that the policy is a generally favorable initiative as it decreased the number of uninsured adults and addressed the issues of the LGBTQ community. However, some elements of the policy should be changed to achieve safety and quality of care. The policy should require medical professionals and staff to adopt equity as a guiding framework and treat diverse patients, including LGBTQ, with respect, as it considerably affects health outcomes (Wilkinson et al., 2017). The transgender patients case from my nursing practice demonstrated how judgmental attitudes and incompetency of medical professionals could lead to unsatisfactory experience, inadequate treatment, and health complications in LGBTQ patients. The HRRP and the HVBP programs penalize safety-net hospitals with 6% of Medicare reimbursements for readmissions, cause adverse outcomes, and exacerbate health inequity towards the disadvantaged Americans (Gaffney & McCormick, 2017). Therefore, readmission penalties on safety-net hospitals should be abolished as they damage the financial stability of well-performing facilities providing care for underserved and vulnerable populations.
References
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring.
Institute for Healthcare Improvement. (2018). The IHI Triple Aim. IHI Institute for Healthcare Improvement. Web.
Mason, D. J., Dickinson, E. L., Perez, A., & McLemore, M. R. (Eds.). (2021). Policy & politics in nursing and health care (8th ed.). Elsevier.
Shin, P., & Regenstein, M. (2016). After the Affordable Care Act: Health reform and the safety net. The Journal of Law, Medicine & Ethics, 44, 585588. Web.
Stimpfel, A. W., Djukic, M., Brewer, C. S., & Kovner, C. T. (2019). Common predictors of nurse-reported quality of care and patient safety. Health Care Management Review, 44(1), 5766. Web.
Wilkinson, G. W., Sager, A., Selig, S., Antonelli, R., Morton, S., Hirsch, G., Lee, C. R., Ortiz, A., Fox, D., Lupi, M. V., Acuff, C., & Wachman, M. (2017). No equity, no triple aim: Strategic proposals to advance health equity in a volatile policy environment. American Journal of Public Health, 107. Web.
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