One important feature of the U.S. health care system that is of particular interest to me is nurse staffing. Nurse staffing has always been a major problem not only for developing and under developed countries but also for the developed nations. In the United States, staffing of registered nurses is an area in health care delivery that has not received much attention despite registered nurses making the largest part of the healthcare staff. There has been uncertainty in nurse staffing with reported layoffs and employment delays in the United States (Mensik, 2013).
The role of nurses in health care is very crucial in as far as reforms towards improved health care provision are concerned. Adequate nurse staffing ensures that patients get quality healthcare services through better care hence promoting patient satisfaction. This being one of the key elements of health care reform indicates how critical nurse staffing is in ensuring improved health care provision. The role of registered nurses in health care reform should not be underestimated as their views are vital in streamlining the healthcare system in terms of patient outcomes, organizational outcomes and nursing outcomes (Mensik, 2013).
There are various challenges specifically related to the passing of the Patient Protection and Affordable Care Act (PPACA). To begin with, the act faces constitutional challenges. There are several litigations from several organs challenging some provisions of the Act which include: 1) the provision on individual responsibility, 2) the provision to expand medical aid to people who were previously not eligible for it, 3) the provision on certain reforms in the insurance especially on renewal of insurance contracts and 4) the provision on employer responsibility in terms of their minimum health insurance contribution to their employees (Silicon Valley Leadership Group, 2011).
The PPACA also faces implementation challenges to get it rolling. This has mainly to do with the health insurance exchanges required to buy and sell health insurance under the Act. In as far as these insurance exchanges are concerned, the challenges include: 1) determining how they are governed, 2) prevention of adverse selection, 3) ensuring compatibility of self-insurance with the state exchanges, 4) ensuring that the exchanges are favorable to employers, 5) the degree of regulation for certification and participation, 6) provision of information to consumers, 7) determination of eligibility aspects, and 8) costs required to attract funding as well as for administration purposes (Silicon Valley Leadership Group, 2011).
Considering the above mentioned challenges to the PPACA, it is clear that the policy-making process has played a role to make health reform in the United States difficult. Some of the policy-making challenges include; 1) legislative efforts are not able to balance both access and costs and usually end up sacrificing access for costs, 2) competition between the government and other forces in the marketplace in terms of regulation of costs and services, 3) there happens to be lack of political bipartisanship in healthcare reform with different sections of the political divide supporting different views, 4) with some of the litigations against the Act coming from the legislature, it is clear that the legislators have competing rather than shared ideologies and 5) some key players in the United States are more interested in safeguarding their economic interests rather than supporting reforms to benefit the majority. They delay reforms that they feel could cause them loses by use of their political, social or economic influence (Walling, 2010).
Mensik, J. S. (2013). Nursing’s Role and Staffing in Accountable Care: Jannetti.
Silicon Valley Leadership Group. (2011). Patient Protection and Affordable Care Act: Challenges and Issues: Retrieved from. http://svlg.org/wp- content/uploads/2011/10/healthcare-issues-white-paper-pdf.pdf
Walling, L. H. (2010). Why is Health Care Reform so Difficult: Retrieved from. http://www.huffingtonpost.com/linda-hanna-walling/why-is-health-care- reform_b_486100.html