To provide the highest standards of care, it is essential to regularly review the performance of the health care system and consider external audits. The Commonwealth Fund, which is a foundation that aims to create a high-performing framework in the U.S. and worldwide, can serve as an example. It regularly releases reports that consider the issues in various nations’ health care systems and the efforts that these countries are taking to address the problems. The specific document that will be used in this paper is the 2017 version, which discusses 18 different countries and provides distinct profiles for them. Though its focus is more on discussing the efforts to improve the current systems, it highlights two prominent issues that need to be addressed.
The first problem discussed in the report is the per capita health spending in the nation. Per Mossialos et al. (2017), the U.S. indicator is the highest in the world and growing at a rate of 4.9% between 2015 and 2016 despite the slowdowns caused by various cost reduction methods. The second prominent issue is the disparity in care in terms of both accessibility and quality. Mossialos et al. (2017) list initiatives such as federally qualified health centers, Medicaid, CHIP, and some provisions of the ACA, but they have not been able to eliminate the issue. While the author does not see any obvious way to address the first problem without a massive overhaul of the system, they may propose a change for the second one.
Disparities are generally considered in terms of race, ethnicity, gender, socioeconomic status, and other statistics. However, Collier-Stewart et al. (2018) argue that such rhetoric is divisive, leading to conflicts where these groups aim to secure a disproportionate degree of access rather than achieve equality, and frequently misleading. The selective choosing of statistics can obscure significant disparities, and Collier-Stewart et al. (2018) suggest that a unified health care framework is necessary to best address all possible concerns. As such, while specialized centers for care are likely still required, they should not become the norm. The ongoing development of accountable care organizations (ACOs) may contribute to such a model, encouraging interprofessional collaboration and focusing on the whole patient or community.
The DNP’s role in the policy that is necessary to achieve this change will involve establishing the notion’s viability and its support through advocacy. To that end, they will have to advance evidence-based practice, improve patient outcomes through collaboration, gather the information that proves the success of the model, and use it to influence policy. According to Chism (2016), it is the DNP’s task as the leader to “assimilate research, practice, and policy” to achieve the best results for the patients (p. 18). In addition to their professional work, they should understand the mechanisms through which they can affect policy creation.
With that said, the process of expanding the reach of ACOs and gathering data about their performance will likely take considerable time. Throughout the period, the DNP will have to engage with the legislature to advance their position and develop an understanding of its workings for the eventual large-scale proposal. Examples include contacting local and state representatives, attending policy meetings, and participating as an advocate. Throughout these practices, the DNP will establish a position as an advocate and gain opportunities to contact influential lawmakers. As such, they will be able to expedite the process and improve the likelihood of adoption when they are ready to propose the change.
Chism, L. A. (2016). Overview of the Doctor of Nursing Practice degree. In L. A. Chism (Ed.), The Doctor of Nursing Practice: A guidebook for role development and professional issues (3rd ed.) (pp. 3-38). Jones & Bartlett Learning.
Collier-Stewart, S., Burston, B. C., Liu, D., & Mulligan, H. H. (2018). The challenges of health disparities: Implications and actions for health care professionals. Jones & Bartlett Learning.
Mossialos, E., Djordjevic, A., Osborn, R., & Sarnak, D. (Eds.). (2017). International profiles of health care systems.