Health Care Policy and Financing - Report Example

Introduction Whole body wellness is a fast developing health phenomenon that needs urgent attention among the people of Gotham, NY. This is because majority of the population in that region have been found to have major health deficiencies such as smoking addiction, obesity and lack of health insurance among most of the populace. The health promotion would therefore seek to address these health problems. To be effective, a modern nurse must balance patient care with staffing; procedures with patient load; egos with patient need; and, fiscal, budgeting with appropriate care. The modern nurse must realize that their position is one of continual multiple horizontal priorities, and act accordingly. As managers, regardless of the subfield, not only to understand the organization’s budgetary concerns, but actively manage them. (Lumby and Picone, 2000). By the very definition of nursing, however, the contemporary nurse must be one of the focal points towards overall healthcare and maintenance for the community. Much like regular maintenance on a vehicle, if nurses can lead a health promotion activity that promotes wellness, over time there would be a far greater chance of diminishing high healthcare and emergency room costs. By educating the population about risk management and proper care, health goals are more likely to be met. HEALTH PROMOTION ACTIVITY – WHOLE BODY WELLNESS Overview Our fictional city is Gotham, NY. The basic demographic data on are summarized below (U.S. Census Data, 2007; Source: NYC City Department of Health and Mental Hygiene): Issue Average Issue Smoking 18% smoke, most are not motivated to quit Gyneco-logical Care Far less likely to get regular testing Insurance 2nd highest population of uninsured adults in all NYC Death Rates Dropped over last 10 years and Obesity 20% obese with high cholesterol, diabetes, and coronary issues HIV Death from HIV dropping, Regular Doctor Over 30% has no regular physician or clinic Overall Analysis for Gotham: Approximately 25% of the population is uninsured, and 25% of the total population has no regular doctor. Access to a regular health care provider helps prevent illness, identify health conditions early, and treat health problems. Both the insurance and regular health care provider issues are linked to poverty. High percentage of obesity, causing 25% of the population to suffer from heart disease, kidney disease, or diabetes. This could be lowered by providing more regular screenings and follow up care. HIV is lower in this area than in most of the borough’s death rates and new infections are low; likely due to a public awareness campaign on prevention and a stronger immigrant population that does not engage in risky behaviors. Smoking is a clear problem as well, with about ¼ of the total population continuing to smoke. Linked also with insurance, a regular doctor, and economic conditions; there is not adequate prenatal care for 15% of the population, and women are less likely to be screened for breast or cervical cancers. Problem Identification Based on the data, there are five major health concerns that affect majority of residents in Gotham. These are: smoking, obesity, diabetes, heart disease and lack of primary care physicians for gynecological issues. Communicable diseases like hepatitis, HIV, STD etc are higher in percentages among the residents in Gotham because of their illiteracy and insufficient health awareness. Therefore, modeling health awareness into a “Wellness Promotion” would stand out as a timely intervention needed to solve the present identified problem. This promotional activity will: i. Last 10 months: Hospitals, clinics, private physicians and dentists, as well as volunteer health care workers and mental health workers shall be used to promote interdisciplinary care. ii. Costs for the event will be shared between four levels: private donations and volunteer; Federal health education funding/grants; State health education funding/grants; and finally local budget and fund drives from Gotham. All interdisciplinary programs in the major hospitals and clinics shall be administered through proposed Federal Grant money. iii. Focus on lowering governmental health costs based on prevention and regular health care. Studies have shown that preventative care (for example, quitting smoking, losing weight, adapting diet) can save over 72% of healthcare costs when compared to cardiac, renal, or pulmonary care costs. This percentage is variable due to individual factors, but may grow into the 90th percentile when one factors in Emergency Room costs for a population largely uninsured (Mahar, 2006). iv. Because this is a community-based effort, it is also likely that quite a number of media outlets will participate without typical costs (see spreadsheet). This would include local television, newspaper, weekly magazines, and the ethnic press. v. Specifically the Wellness Program will address: Ways to Quit Smoking, Healthy Diet and Weight Loss, Exercise Programs, Gynecological and Pre-Natal Care. Secondarily, other participants will include general clinical advice, STD testing and care recommendations, and mental health concerns. B. Budget This is a macro version of an expected budget also listing projected incoming funds based on previous activities of a similar nature. Fixed costs assume funding. Table 1 - Overall Budget Type Admin. Promotion Equipment Supplies Hr/R Fixed Staff of 3-4 Professionals, at least one MD, 2-RN, 1 Healthcare Admin; ($300-500,000) Preliminary promotion $50,000; monthly promotion $20,000 ($270-300,000) 2 Equipped mobile clinics; laptops, cellphones, office equipment (leased)- mobile vehicles purchased by hospitals after program completed. ($500-650,000) Misc. admin supplies; medical supplies (swabs, syringes, etc.) NOT including OTC or Rx materials. ($150-200,000) See Admin. This may increase based on the scope and what institutions can donate in terms of time and resources. ($100-250,000) Fixed Grant $2.5M Grant $200,000 Grant $500,000 Grant $100,000 Grant $700,000 Variable Certain localized promotions may require additional supplies. ($100,000) Program could progress to the point where additional Mobile Clinics were needed based on participation and individual community ,support and need. ($150,000 per) Certain localized promotions may require additional supplies. ($100,000) Planning on staffing with volunteers but funds needed for some travel, food to volunteers, misc. expenses. Planning at least 10 volunteers per area, total of 100-150 volunteers. ($100-150,000) Controllable Controllable in scope and dependent upon matching funding, based on scope = ($1M-1.5M) Controllable in scope and use, dependent upon donations from pharmaceutical companies, clinics, etc., based on the scope with no Rx included= ($200-500,000) Controllable in scope and dependent upon matching funding, volunteers, base 10 staff and 20 volunteers per month; based on scope = ($800,000 - $2.2M) Unrecoverable Preliminary Research and Grant Preparation ($50,000) All preliminary supplies; computer rental, publications, fees, travel, etc. ($20,000) Personnel Time for research and development; absorbed by other departments. ($50,000) TOTAL $1.35-1.5M $370,000 $650-800,000 $470-820,000 $1.05-2.45M PLANNED DONNATIONS Television, Newspaper, Radio, at least double the budget with 50% discount or more Medical equipment hopefully donated by manufacturers or sold at cost. Medical supplies hopefully donated by manufacturers or sold at cost Either volunteer personnel or hospitals and clinics allowing staff to work on project while being paid for a regular job. Table 2 - Developed Gross Budget Source Amounts Notes Total Budget (high side) $5.9M Probably round to $6M to be safe Federal HHS Grant $4M Ask for the total of $6, knowing much will be cut; offer additional programs based on money in. State Health Grant $1M Dependent on Federal Grant Local Gotham Contribution $500,000 Dependent on Federal Grant Volunteer, Medical Company Contribution $750,000 With appropriate admin and PR, hoping this will grow Total $850 slush C. Cost Benefit Analysis If we extrapolate the July 2008 (U.S. Census) population estimate for Gotham at 2.3 million we find that approximately 30 percent are at risk for one of the major identified health concerns, or approximately 700,000 individuals. The average cost for smoking related care for each person is of an average of $200,000, This is a working average for pulmonary and renal care (of course, dependent on length of life, seriousness of care, etc.). We will thus use a working average of the care of a population of 700,000 individuals at $200,000 per annum (health care, lost productivity, economic costs, social costs) for 700,000 X $200,000 = $1.4 Billion Dollars per annum. The cost benefit seems obvious; even if half of those costs in time, productivity and medical costs ($100,000 per individual) were recouped, we would find savings of $700M per annum in preventative health care, not to mention the greater macro benefits towards education and future illness (See: “Smoking and Your Wallet,” 2009; Harris, 1993). Value for Money in Implementation If a successful CEO of a major corporation was asked whether if the company made an investment of $6M and in one year saw potential of at least a $700M savings in costs, if that would be of interest, it is quite likely the company president would jump on such an opportunity. Typically, in business, executives are happy if they double their investment in a calendar year. In the Gotham example, however, the benefits are almost immediate. Let us take a more conservative scenario though. We have a population of 700,000 at risk. We know that the economic and health care cost is about $200,000 per person based on their habits or condition. Let us say that despite all our efforts, we only reach 10 percent of those individuals, or 70,000. We have still saved $14M in the first year, again, not counting the longitudinal costs benefits and educational issues. In fact, our break even number is that we reach just 30 individuals (4.28 percent of the at-risk population). Even by direct mail standards without intervention this is a very reasonable figure. We must also take into consideration that some of the at-risk population will not attend the events or come to the Free Mobile Clinic, but we must also balance that with others who will come that are not quite at-risk but may in the future be. In other words, if only one individual changes his or her habit each week based on school visits, clinics, advertisements, and information; we have more than made an even ROI on the investment short-term. Are there downsides? Certainly, the model is based on a large Federal Grant and magnanimous participation by local, regional, state, and multinational health care and pharmaceutical individuals and companies. However, noting that Gotham has a number of teaching hospitals and that medical equipment companies are facing public relations issues – combined with the extreme negativity the public feels towards the pharmaceutical industry, it is more than likely that these donations or cost savings would occur. REFERENCES Buerhaus, P. and Needleman J. (2000). Strategies for addressing the evolving nursing crisis. Accessed September 15, 2012 from http://www.nyc.gov/html/hhc/html/facilities/Gotham.shtml Clark, J. (2005). Improving Hospital Budeting and Accountability: A Best Practice. Economic Review. 197(2006): 80. Community Health Profiles (2006). New York City Department of Health and Mental Management. Journal of International Studies. Vol. 3(2) Fabre, J. (2005). Smart Nursing: How to Create a Positive Work Environment That Empowers and Retains Nurses. New York: Springer. Gotham Hospital Center (2008). New York City Health and Hospitals Corporation. Journal of International Studies. 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Strategic Crossroads (2009). Smoking and Your Wallet. Cited in: Healthcare Financial Management 1(1): 5-15. U.S. Census Data (2007). Current Data on Gotham, New York: PrintWell Publications Read More