to be 83.7 million, almost double its estimated population of 43.13 million in 2012. With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases and comorbidities. With an aging nursing workforce (Norman et al., 2005), more nursing faculty is needed to train larger numbers of students.
Case Study 2.2
Review the ratings of hospitals in your area of the country at www.healthgrades.com, www.hospitalcompare.hhs.gov, www.100tophospitals.com/top-national-hospitals, and the U.S. News & World Report Best Hospitals, annual ranking, available at http://health.usnews.com/best-hospitals
What kinds of ratings are given to hospitals in your area?
Review the criteria and evaluation system used to rate the hospitals. Is it valid and reliable?
Will you choose a hospital for your own family's care using a rating system like this?
American Nurses Association
The ANA is a full service, professional organization representing the nation's entire RN population. The ANA represents the 4 million RNs in the United States through its 54 constituent state and territorial associations. The ANA's mission is to work for the improvement of health standards and availability of health care services for all people, foster high standards for nursing, stimulate and promote the professional development of nurses, and advance their economic and general welfare (ANA, 2019).
The National Labor Relations Board (NLRB) recognizes the ANA as a collective bargaining agent. The fact that the ANA has a dual role of being a professional organization and a collective bargaining agent causes controversy. Some nurses believe that unionization is not professional and that the ANA cannot truly support nursing as a profession if it is also a collective bargaining agent. Nurse managers are excluded from union membership. The ANA lobbies Congress and regulatory agencies on health care issues affecting nurses and the general public. The ANA initiates many policies involving health care reform. It also publishes its position on issues, ranging from whistle blowing to patients' rights. The American Nurses Credentialing Center (ANCC), a subsidiary of the ANA, created the Magnet Recognition Program to recognize health care organizations that provide the very best in nursing care. Since 1994, many institutions have received this award.
In this chapter, we have explored how health care is organized and financed in the United State, compared U.S. Health care with that of other industrialized countries, identified major issues facing health care, and related efforts for improving the quality, safety, and access to health care. Staying abreast of U.S. health care and health care in other countries is part of being a registered nurse and understanding the environment in which we work.
KEY CONCEPTS
Health care reports provide invaluable information that emphasizes the successes and failures of health care throughout our nation.
Evidence of significant disparities and low quality continue to demonstrate the need for significant health care improvement.
Today, leaders, managers, and staff need to be aware of and involved in the ongoing processes of the making of health policy.
Health care systems have three simple components: structure, process, and outcome.
The United States is one of only a few advanced countries in the world without a universal system of health care.
In the United States, the emphasis on acute care health care services has successfully driven health care costs higher, but has not necessarily improved the quality of care or patient outcomes.
Primary care provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Patients and clinicians need to work together to appropriately utilize services based on the following four foundations of primary care: First Contact, Longitudinality, Comprehensiveness, and Coordination.
The federal government is a major driver of health care organization and delivery.
Today, almost as many persons receive health care in the home as receive health care in acute‐care settings.
Enabling factors such as income, type of insurance coverage, gender, race or ethnicity, geographical proximity, and system characteristics affect a person's ability to have access to health care.
The 2010 passage of The Patient Protection and Affordable Care Act and the HCERA has made changes in the U.S. health care system.
The elderly have a form of UHC coverage through Medicare.
Because the United States does not have national/UHC insurance, public health care programs are intended to fill the gap.
Health care spending continues to increase faster than the overall U.S. economy.
There are many contributing factors to the rising costs of health care. The key factors include the aging of the population with growth in the demand for health care, increased utilization of pharmaceuticals, expensive new technologies, rising hospital care costs, practitioner behavior, cost shifting, and administrative costs.
Because rising health care costs are based on utilization, it is important to understand other factors that can both increase and decrease utilization.
Capitation and prospective payment have had some of the most significant impacts on cost containment.
The report To Err Is Human, confronted health care clinicians and managers with concerns about the poor quality of health care attributable to misuse, overuse, and underuse of resources and procedures, which was responsible for thousands of deaths (IOM, 1999).
The report, Crossing the Quality Chasm (IOM, 2001) and several large studies (McGlynn et al., 2003; Thomas et al., 2000) have shown that the quality of health care in the United States is at an unexpected low level and needs improvement in many dimensions, given the amount of money the United States spends on health care.
Groundbreaking research, beginning in the mid‐1980s and continuing in the 1990s, demonstrated that there was significant variation in utilization of specific health care services associated with geographical location, provider preferences and training, type of health insurance, and patient‐specific factors such as age and gender.
Recent research findings illustrate the need for significant improvements in the process of health care delivery.
Health care performance and quality are measured to determine resource allocation, organize care delivery, assess clinician competency, and improve health care delivery processes.
Public reporting of organizational performance and quality information is being driven by several forces.
Several key national public quality reports of interest for health care and nursing leaders and managers for purposes of performance measurement and benchmarking are available.
A key challenge for health care is the numerous deficiencies in the delivery of care of patients with chronic conditions.
Evidence‐based practice involves supplementing clinical expertise with the judicious and conscientious implementation of the most current and best evidence along with patient values and preferences to guide health care decision making.
Health care accreditation is a mechanism used to ensure that organizations meet certain national standards.
There is a need to focus on retooling the health care workforce with new knowledge and requisite skills to function in better, redesigned health care systems.
Health professionals'