Question

• How do the rapid and dynamic changes in financing impact health outcomes within your practice? Also, In what ways can an understanding of health care financing better equip nurses to be more effective advocates?

Answer 1

Financing, insurance, delivery and reimbursement are the four functional components make up the quad-function model. The four functions generally overlap, but the degree of overlapping varies between a private and government-run system and between a traditional health insurance and managed-care based system. Financing is necessary to obtain health insurance or to pay for health care services.

Financing determines who has access to health care. As its central role, health services financing pays for health insurance premiums to cover individuals and families. Health insurance is the primary mechanism that enables people to obtain health care services.

Financing is state based with federal matching based on the per capita income in each state. Fed matching aka Federal Medical Assistance Percentage (FMAP) - cannot be less than 50% nor greater than 83% of total state Medicaid program costs. Therefore, wealthier states have a smaller share of their costs reimbursed by the federal govt. Eligibility is determined through means-testing for those not automatically qualified. Automatic qualification goes to:

1) Families with children receiving support under Temporary Assistance for Needy Families (TANF) program,

2) People receiving SSI, which includes many of the elderly, the blind, and the disabled with low incomes,

3) Children and pregnant women whose family income is at or below 133% of the FPL,

Nurses need to know basic information about health care financing because it impacts clinical decision making in health care agencies. Future proposed changes in reimbursement could dramatically change health care delivery as we know it today.

"It's important to vote for the political party that I believe has the best health-care reform policy." "It's important for nurses to advocate for their clients by calling for all political parties to address important health-care policy decisions in an atmosphere of problem solving, compromise, and responsibility."

Work with professional and specialty nursing organizations to shape a public policy agenda around SDOH. This may also include drafting position papers, writing legislative officials, and joining forces with other nursing and non-nursing likeminded groups. Educate patients and communities about SDOH.