Health Care Finance, Economics, and Policy for Nurses: A Foundational Guide

by Betty Rambur PhD, RN, FAAN

Overview

The complexities of health care finance, economics, and policy today are inextricably intertwined with traditional nursing practice. This undergraduate nursing text distills these challenging topics into an engaging, easy-to-read format that facilitates ready application to any practice setting. Written specifically for RN to BSN and second-degree nursing programs, the book is the only such text grounded in nurses’ own understanding and experience. Concise and practical, it supports foundational concepts with real-life case studies and clinical applications and reinforces information with interactive quizzes and multimedia materials. The book’s content fulfills one of the AACN’s key Essentials of Baccalaureate Education. Written by a health economics and policy expert, former dean, and award-winning teacher, the text synthesizes the vast scope of health economics to create an easily understandable guide for nursing action from bedside to boardroom.

The text describes the relationship between nursing and health care economics and traces the history of our health care system from the early 1900s through today. It contrasts the economics of health care with that of classic free markets and discusses the intersection of ethics and economics, providing nurses with the ethical tools to thoughtfully consider dilemmas arising from today’s focus on the bottom line. The book describes how to use economic principles to shape organizations and public policy and includes a step-by-step, skillbuilding guide to enhancing professional influence through participation on governing boards. Complex financial principles are broken down to facilitate understanding for nurses with no prior knowledge of this discipline. The book also includes relevant information on the Patient Protection and Affordable Care Act and is compatible with online teaching and coursework. Faculty resources include PowerPoint slides, a test bank, comprehensive review questions, and sample syllabi.

KEY FEATURES:

• Fulfills one of the key Essentials of Baccalaureate Education
• Addresses the specific needs of RN to BSN courses with a concise, easy-to-read format
• Illuminates complex principles with specific, engaging case examples relevant to nursing practice
• Authored by a leading nurse expert, health policy leader, former dean, and award-winning teacher
• Guides readers in using economic principles to shape organizations and public policy

Product Details

ISBN-13:	9780826123237
Publisher:	Springer Publishing Company
Publication date:	04/16/2015
Sold by:	Barnes & Noble
Format:	eBook
Pages:	256
File size:	2 MB

About the Author

Betty Rambur, PhD, RN, FAAN, is the Routhier Endowed Chair for Practice and professor of nursing at University of Rhode Island.

Table of Contents

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Betty Rambur, PhD, RN, is a professor of nursing and health policy at the University of Vermont (UVM). From 2000 to 2009, she served as an academic dean at UVM, where she led the merger of the School of Nursing and the School of Health Sciences to establish the College of Nursing and Health Sciences. These experiences have built on Dr. Rambur’s substantive leadership history in health policy and finance. From 1991 to 1995, she led the statewide health financing reform effort in North Dakota. An RN, Dr. Rambur received her PhD in nursing from Rush University in Chicago, Illinois. She maintains an active research program focused on health services, quality, workforce, and ethics. She has led or participated in research, education, and public service grants exceeding $2 million, is the author of about 40 published articles, and has made numerous invited presentations on her research, health care economics and policy, and leadership development. In 2007, her research was honored by Sigma Theta Tau International. Dr. Rambur is also an accomplished teacher in both classroom and online venues. In May 2013, she received the UVM Graduate Student Senate Excellence in Teaching Award, and in November 2013, she received the prestigious Sloan Consortium Excellence in Online Teaching and Learning Award. Her teaching expertise includes the organization, finance, and policy of health care, payment reform, and evidence-based practice. Dr. Rambur was appointed to Vermont’s Green Mountain Care Board by Vermont’s Governor Peter Shumlin in August 2013. The five-member Green Mountain Care Board is a quasi-judicial body. It oversees Vermont’s financing, payment, and delivery reform and holds board regulatory, innovation, and evaluation authority.

CONTENTS

Foreword Susan B. Hassmiller, PhD, RN, FAAN, and Susan Reinhard, PhD, RN, FAAN

Preface

Acknowledgments

SECTION I. THE CONTEXT OF HEALTH CARE AND HEALTH CARE REFORM

1. What Is Health Economics and Why Is It Important to Nurses?

Theoretical Economic Approaches

Social Determinants of Health

How Economics Differs From Financing and Reimbursement

Insurance Industry Changes Since the Passage of the ACA

Conclusion

2. A Story of Unintended Consequences: How Economic and Policy Solutions Create New Challenges

The Influence of the Flexner Report

Early Hospitals

Social Reform Addressing Unintended Consequences of Employer-Based Insurance

Attempts to Change Finanical Incentives to Contain Costs

The ACA and New (and Renewed) Payment Models

3. Payment Reform

From Volume to Value: Payment Models That Move Away From Fee-for-Service Reimbursement

Nursing Roles Within Emerging Payment Models

SECTION II. HEALTH CARE ECONOMICS: AN OVERVIEW

4. How Health Care Markets Differ From Classic Markets

What Does It Mean to Bear the Consequences of Financial Decision Making?

What Ideas Help Us Understand Overtreatment? The Example of Small-Area Variation and Supplier-Induced Demand

5. The Role of Information in Health Care Markets and Decision Making

The Need for Information

Data on Quality

Big Data

Meaningful Use

Information Science, Quality Science, and Data

6. Market Entry, Exit, and Antitrust Law

Entering and Exiting the Market

Merge, Consolidate, or Stand Alone: An Overview of Antitrust Law

Is Consolidation the Same as Integration?

SECTION III. ETHICS AND ECONOMICS IN AN AGE OF REFORM

7. What Is Ethinomics?

Can Economics Coexist With the Intention of “Doing Good”?

Social Determinants of Health, Health Disparities, Ethics, and Economics

Moral Conduct of Nurses in Contemporary Complexity

8. Additional Models to Guide Ethical Decision Making

Consequence-Based Decision Making

Deontology: Rule-Based Decision Making

Virtue Ethics

Using These Models in Clinical Decision Making

Moral Distress

Ethics of Reform and Cost Containment

Sustainability Is an Ethical Issue

Nurses on Boards and in Politics

SECTION IV. PULLING IT ALL TOGETHER: USING YOUR KNOWLEDGE OF HEALTH FINANCE, ECONOMICS, AND ETHICS TO INFLUENCE HEALTH AND HEALTH CARE

9. Governance and Organizational Type

Role of the Board of Trustees

Types of Hospitals and Health Systems

Navigating Governance–Management Boundaries

The Relationship Between Organizational Structure and Organizational Values

The Role of Board Committees

The Sarbanes–Oxley Act

10. Building Skills for Board Membership

Zeal, Organizational Fit, and Philanthophy

Types of Board Appointments

What a Governing Board Is Not

Other Types of Boards

Building the Skill Set for Board Membership

Next Steps

11. Applying Health Economics to Influence Health Care Through State and Federal Policy Formation

Ways of Influence

How to Contact Policymakers

Maintaining a Connection with Policymakers to Influence Health and Health Care

Overcoming Impediments to Involvement

12. Epilogue: Reflections on Living and Leading in a Changing Nursing World

Tell Me One More Time: What Does All This Financing, Economics, and Policy Have to Do With Nursing?

How to Retain and Expand on What You Have Learned

Appendix: Quiz Answers

Glossary

Index

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