Healthcare policy is an integral aspect of the U.S. healthcare system—one that helps shape and protect the health and well-being of our population. Policy impacts issues as fundamental as healthcare access, cost, delivery methods, and privacy. It involves the rules and regulations set forth by lawmakers on a local, state, and national level.
As a current or future nurse, you should know what healthcare policy is, how it works, and why it’s important—so that you can use your expertise to help shape new policies. Or if you’re a health administrator, your understanding and involvement in health policy will help you optimize current policies and guide teams to follow them. In this post, we’ve outlined what you need to know about healthcare policy, including how you can advance your career as a health advocate and policymaker.
The term “healthcare policy” refers to the decisions, goals, and actions that determine how care is administered and accessed. ((Ballotpedia, “Healthcare Policy in the United States”: https://ballotpedia.org/Healthcare_policy_in_the_United_States)) For example, policies can include legal and safety regulations by state or protocols regarding how care and medicine are delivered to patients at a specific hospital. “Healthcare policy” also refers to the policies set on a national level, in terms of access to healthcare, coverage, and cost.
Subcategories of health policy include public health, global health, healthcare services, health insurance, mental health, and pharmaceuticals.
Healthcare policy is important because it helps establish guidelines that benefit patients, healthcare organizations, and our healthcare system. Having protocols in place can help prevent human error and poor communication around medical decisions.
For nurses and health administrators, understanding and following policies can help ensure that you deliver the best care to patients while using your knowledge to help inform future policies. On a broader level, when patients take the time to understand healthcare policy, they learn more about their rights.
To be able to maintain quality care for patients, organizations must set policies to address the following aspects of their operations. ((PowerDMS, “Examples of Healthcare Policies,” Dec. 22, 2020: https://www.powerdms.com/policy-learning-center/examples-of-healthcare-policies))
Patient care policies cover protocols and workflow for treatment procedures, outlining how healthcare professionals should respond to specific medical situations. Of course, policies must be tailored to the care your facility provides. For example, a cancer center would create different patient care policies than would a center for rehabilitative medicine , because their treatment protocols are so different.
The health of employees is a crucial component of running an effective facility, as staff must be able to care for patients safely, while maintaining their own well-being.
Examples of policies designed to protect and promote employee health include rules around the consumption of alcohol and tobacco in the workplace, wearing masks and gloves to minimize the risk of exposure to illnesses and chemicals, and wellness policies such as time off and healthy eating.
Drug policies outline procedures around the handling and administering of pharmaceuticals, whether the medication is over-the-counter, controlled, or non-controlled. This can include protocols for recording, handling, and delivering each medication. ((Kimberly New, “Drug Diversion Regulatory Requirements and Best Practices,” Patient Safety & Quality Healthcare, Nov. 18, 2020: psqh.com/analysis/drug-diversion-regulatory-requirements-and-best-practices/)) Drug policies also cover what to do if inventory is missing, if medication was incorrectly administered or prescribed, or if any other errors occur related to drug handling.
Security policies clearly outline how employees should handle situations that pose a security threat in their facility. This can include situations like abuse towards medical staff, patient abductions or elopements, theft, and active shooters. ((Lowers & Associates, “5 Current Threats to Hospital Security,” The Risk Management Blog, March 28, 2018: https://blog.lowersrisk.com/threats-hospital-security/)) If a facility has security processes, these must be clearly outlined for all employees to know and follow.
Aside from physical security, data privacy and technology security policies and procedures are extremely important in any healthcare facility. The HIPAA Privacy Rule protects patient information from release to the public, while permitting the exchange of this information if needed between medical professionals and in certain other situations. Failure to comply with HIPAA can result in fines of $50,000 or higher per violation. ((Alex M. Azar II, “Annual Civil Monetary Penalties Inflation Adjustment,” U.S. Department of Health & Human Services, January 17, 2020: https://www.govinfo.gov/content/pkg/FR-2020-01-17/pdf/2020-00738.pdf))
The more that technology becomes an integral component in how healthcare facilities operate, the greater the chance that data leaks and privacy breaches can occur. In 2020, there were 600 healthcare breaches, a 55 percent increase from 2019. The average cost per breached record is now almost $500. ((Bitglass, “Healthcare Breach Report 2021: Hacking and IT Incidents on the Rise,” Feb. 17, 2021: https://pages.bitglass.com/rs/418-ZAL-815/images/CDFY21Q1HealthcareBreachReport2021.pdf)) This is why it’s crucial that facilities clearly specify policies and procedures regarding the handling of data to avoid errors that can result in privacy leaks.
For many families, healthcare takes up a huge portion of their budget. There is an ongoing debate over who has access to coverage and why the costs of care are so high in the United States, which is why some policymakers are trying to find solutions to improve access to affordable and quality care for all. Below, we explore a few major health policy issues impacting Americans today.
In 2019, 92 percent of Americans had some form of healthcare coverage—whether employer-provided coverage, Medicare or Medicaid, or private health insurance. ((Katherine Keisler-Starkey and Lisa N. Bunch, “Health Insurance Coverage in the United States: 2019,” United States Census Bureau, Sept. 15, 2020: https://www.census.gov/library/publications/2020/demo/p60-271.html)) Increasing the number of insured individuals has been the focus of many policymakers. The Affordable Care Act, implemented in 2010, played a major role in increasing the number of insured Americans. ((Digital Communications Division, “What Is the Affordable Care Act?” U.S. Department of Health & Human Services, last reviewed Aug. 4, 2017: https://www.hhs.gov/answers/affordable-care-act/what-is-the-affordable-care-act/index.html))
Although the percentage of uninsured individuals has decreased, policymakers have diverging viewpoints around this issue. Some policymakers are pushing for higher participation in employer-provided coverage, while others are advocating for Medicare for all.
Even with health insurance, many individuals still face overwhelmingly high out-of-pocket healthcare costs. In the wake of the COVID-19 pandemic, it has become even more imperative for lawmakers to find an affordable solution for Americans. ((HealthPay24, “8 Policy and Political Issues That Will Impact Healthcare in 2021 and Beyond,” Oct. 28, 2020: https://www.healthpay24.com/blog/policy-political-issues-impacting-healthcare-2021))
To address these high costs, policymakers have discussed finding a way to lower prices without compromising the quality of the services and care provided. Some solutions include significantly reducing prescription drug prices or allowing policymakers to regulate healthcare prices. Introducing government-run, public insurance options that pay lower prices than private providers is also another option that’s periodically on the table. The public option would make health insurance more accessible to those who can’t afford the premiums of private health insurers. And competing with the public option could pressure private insurers to lower their costs. ((Matthew Fiedler and Christen Linke Young, “Current Debates in Health Care Policy: A Brief Overview,” Brookings, Oct.15, 2019: https://www.brookings.edu/policy2020/votervital/current-debates-in-health-care-policy-a-brief-overview/))
Addressing issues related to the socio-economic conditions in America’s communities can help improve the overall health of individuals in these populations. ((AHIP (America’s Health Insurance Plans), “4 Issues Shaping Healthcare Policy,” April 8, 2021: https://www.ahip.org/4-issues-shaping-health-care-policy/)) Some public health clinics and nonprofits are working to provide wellness counseling and other services to people beyond just medical needs. This includes access to healthy food, affordable housing, transportation, childcare services, education, and more. A healthy population leads to better outcomes and more affordable care for all. (( Kate Berry, “How Health Insurance Providers Are Tackling Social Barriers to Health,” The American Journal of Accountable Care , Dec. 2019: https://www.ajmc.com/view/how-health-insurance-providers-are-tackling-social-barriers-to-health ))
If you’re interested in helping shape the future of our healthcare system, below are a couple of career paths you can take.
Healthcare policy analysts play a huge role in making effective changes to our healthcare systems. They are responsible for evaluating current policies and suggesting improvements that can impact patient care. These analysts use critical thinking skills to compile and evaluate relevant data and research, suggest changes to current policies, and create new policy proposals. ((Chegg Career Match, “Health Policy Analyst”: https://www.careermatch.com/job-prep/career-insights/profiles/health-policy-analyst/)) Their day-to-day tasks include meeting with lawmakers, raising public awareness about healthcare policies, and reporting and presenting their findings.
Most healthcare policy analysts start by earning an undergraduate degree in public health, public policy, political science, government, or a related field. From there, you can move on to a Master of Health Administration (MHA) degree at a school such as the University of St. Augustine for Health Sciences (USAHS). In our MHA program, you’ll gain the skills you need to oversee key areas of healthcare organizations, such as health informatics, finance, human resources, and operations.
Nurse practitioners (NPs) can also play an important role in healthcare policy. Because they work directly with patients, nurse practitioners offer an insider’s perspective that complements the experience of government officials and policymakers. NPs and other nurses can help identify problems within the current healthcare system, come up with solutions, and suggest new policies that can positively impact the well-being and safety of their patients.
In the USAHS Doctor of Nursing Program (DNP) degree program, you can further your knowledge in the areas of healthcare policy, leadership, and advocacy. You can also earn a role specialty as a family nurse practitioner .
Healthcare policy is important on a macro and micro level. It affects our whole society, as well as each community and facility where care is administered. If you’re looking to make an impact in healthcare and want to be an advocate for change, check out USAHS’ graduate degrees to find a career path that’s right for you.
The University of St. Augustine for Health Sciences (USAHS) offers Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and Post-Graduate Nursing Certificates designed for working nurses. Our degrees are offered online, with optional on-campus immersions* (resuming in Spring 2022). Role specialties include Family Nurse Practitioner (FNP), Nurse Educator ,** and Nurse Executive . The MSN has several options to accelerate your time to degree completion. Earn your advanced nursing degree while keeping your work and life in balance.
USAHS offers a Master of Health Administration (MHA) program designed for working healthcare professionals who want to improve systems of finance, informatics, operations, policy, and other key functions of healthcare organizations. The program is taught online, with optional on-campus immersion weekends (scheduled to resume in 2022) and an optional internship. Whether you choose the traditional or accelerated track you will gain real-life experience and expand your professional network. During your capstone project, you will work with an industry mentor.
The University of St. Augustine for Health Sciences (USAHS) offers an online EdD program focused on healthcare education. Designed for working clinicians and healthcare educators, the program has two required residencies and optional on-campus immersions (resuming in Spring 2022) . Specializations include Nursing Education, Athletic Training, Teaching and Learning (with a teaching internship), and Executive Leadership. Design a customized plan of study that takes advantage of our acceleration options and wide array of electives—and prepare to educate the next generation of healthcare professionals.
*The FNP track includes two required hands-on clinical intensives as part of the curriculum.
**The Nurse Educator role specialty is not available for the DNP program.
