Health Care Reform and Public Health Nursing

A recent estimate of the magnitude of rising health care costs in our nation is that by the year 2000 it will take the total salaries of all working Americans to meet these new costs. Considering also the predictions that Americans over the age of 65 will double to 70 million in the next decade and that there will be a ten-fold increase (from 1.5 million to 12-18 million) in AIDS cases and an additional 30-40 million persons infected with HIV around the world by the year 2000 (World Health Organization, 1992), this estimate of the magnitude of future health care costs may be conservative. Further, recognizing the other health care needs that will accompany these events, it does not take a crystal ball to predict that we are confronted with awesome challenges for the delivery of health care services. Few disagree that something must be done now to institute health care reform. Health care reform involves all of us and is not simply a matter of obtaining more funding. Yes, we do need to be more efficient, but we also need to be more appropriate and acceptable in our service to the public. How is public health nursing education, practice, and research responding to these challenges? Are we dealing appropriately with the issues of a radically changing profile of clients in the context of shrinking resources? What about these changes and the escalating need for community oriented primary health care? What will really be relevant for public health nursing and its role in meeting present and future health care needs? How will we “fit in” with new reforms in health care? What does this all mean for us and what must we do now? May we consider that the vision we create and the action we take be in collaboration with each other and with other health care professionals, evaluate what we are doing that enhances not only services, but health, and envision the future we want to create, rather than be swept along by events. In order to do this, we need to define new agendas and make relevant changes in public health nursing academic education, practice and research. The relevancy of our work for the future of the “public’s health” is crucial. We must look at the

bridges we are building and remove the existing gaps. There will be little time for resistance at any point. Moreover, the present changes in health care delivery will demand restructuring of our organizational culture. This includes changes in leadership orientations, and increasing flexibility to accommodate flattening of organizational authority systems. Incorporated in these changes are needs for the implementation of a more collaborative model of team building for the delivery of public health nursing services. Collaborative models should include the consumers of our services to whom we must listen. Cultural issues in health care reform, too, have major implications for the provision of relevant health care services. To only address health care costs by providing insurance coverage is not enough. We also need to think about the relevancy and acceptability of that care in terms of a diverse cultural context. Culture being here broadly defined as not only identifiable in an ethnic context, but as incorporating the sub-cultures found within every racial group, where there is diversity of belief systems. The availability of insurance coverage for only traditional models of health care services does not assure the utilization of these services or healthy outcomes. New systems of coverage for health care services must incorporate the values and beliefs of the constituency being served and provide acceptable alternatives for care and a choice of providers. These few random thoughts only address superficially a need for some major rethinking of the implications of health care reform for public health nursing and our role in creating the vision that will make it happen for the benefit of our constituents. You are encouraged to further respond to the issues of health care reform and its application for public health nursing. Examples of how you are dealing with these issues are needed for publication in our section, “Notes from the Field.” We need to have a dialogue in order to work toward a solution. We look forward to hearing from you! Katherine Young Graham


Health care reform and public health nursing.

EDITORIAL Health Care Reform and Public Health Nursing A recent estimate of the magnitude of rising health care costs in our nation is that by the y...
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