Discussion Week 3: Initial Post
As registered nurses, our job is to provide holistic, patient-centered care, which is often accompanied by long hours and extremely challenging patient situations. On top of this, we must maintain a balance between competing needs and limited resources. Kelly and Porr note that in recent decades, many hospitals have switched from a treat-heal-care model to a more corporate business prototype that focuses on efficiency and profit, rather than patient outcomes (2018). With this model, it seems that more resources and staff are geared towards areas of the hospital that will profit the hospitals. At CoxHealth, the hospital revenue primarily comes from surgeries and primary care clinics (Haefner, 2018). Both Medicare and private insurers tend to pay more for such procedures and preventative care (Abelson, 2020).
With this model, there are fewer incentives to provide high-quality, affordable, and convenient healthcare to individuals who do not have private insurance or are uninsured. For example, CoxHealth refers patients who do not have insurance to their Family Medical Care Center (FMCC), which is primarily run by resident physicians. As these resident physicians have recently graduated medical school, they are still learning, and sometimes do not always provide the highest quality of medical care. They also lack resources and staff that the family practice clinics only serving private and Medicare-insured individuals have access to. This creates an ethical dilemma as these patients still deserve high-quality patient-centered care even though they may lack financial resources.
For this reason, there are policies in place to protect this vulnerable patient population and address these competing needs. Individuals who do not have health insurance are primarily in a lower socioeconomic class, which is linked to poor health outcomes and increases the risk of behavioral health issues and substance abuse (Pampe et al., 2010). CoxHealth partners with Jordan Valley and Burrell Behavioral Health, which are community health centers that aim to serve uninsured individuals by offering high-quality, patient-centered care. According to the Springfield Business Journal, Jordan Valley Community Health Center obtained a federal government-issued grant of $2 million to improve access, resources, and adequate staffing needs to care for uninsured individuals seeking primary care. Also, Burrell Behavioral Center received $4 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand access to mental health and substance abuse treatment for uninsured individuals living in southwest Missouri (2020).
It is clear that lower socioeconomic classes may not always receive the highest quality care from hospitals biased towards allocating resources to the areas that create high-profit margins. As nursing leaders, we must balance the organization's needs and ensure quality, effective, and safe patient care.
Abelson, R. (2020). Hospitals Struggle to Restart Lucrative Elective Care After Coronavirus
Shutdowns. Retrieved September 12, 2020, from https://www.nytimes.com/2020/05/09/health/hospitals-coronavirus-reopening.html
Burrell Behavioral Health. (2020). Burrell Behavioral Health awarded $4 million CCBHC
Expansion Grant. Retrieved September 12, 2020, from https://www.burrellcenter.com/media/burrell-behavioral-health-awarded-4-million-ccbhc-expansion-grant/
Haefner, M. (2018). CoxHealth's net income falls 40% in FY18: Springfield, Mo.-based
CoxHealth saw its net income fall in the fiscal year ended Sept. 30, 2018, according to recent financial documents. Retrieved September 12, 2020, from https://www.beckershospitalreview.com/finance/coxhealth-net-income-falls-40-in-fy18.html
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to
enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. Doi:10.3912/OJIN.Vol23No01Man06. Retrieved September 12, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert
clinician to influential leader (2nd ed.). New York, NY: Springer.
Pampel, F., Krueger, P., & Denney, J. (2010). Socioeconomic disparities in health
behaviors. Retrieved September 12, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169799/
Springfield Business Journal. (2020). Federal government issues $2M grant to Jordan Valley.
Retrieved September 12, 2020, from https://sbj.net/stories/federal-government-issues-2m-grant-to-jordan-valley,68434