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EDITORIAL | 1 October 2021 as of the publication date.

Healthcare Policy: What Is It

and Why Is It Important?

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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

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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.

What Is Healthcare Policy?

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.

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Subcategories of health policy include public health, global health, healthcare
services, health insurance, mental health, and pharmaceuticals.
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Why Healthcare Policy Is Important
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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.

Examples of Healthcare Policies

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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

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.

Employee Health Policies

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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

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-
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practices/)) Drug policies also cover what to do if inventory is missing, if
medication was incorrectly administered or prescribed, or if any other errors
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Security and Privacy Policies
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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

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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.

Healthcare Policy Issues

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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.

Healthcare Coverage

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
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of Health & Human Services, last reviewed Aug. 4, 2017:
https://www.hhs.gov/answers/affordable-care-act/what-is-the-affordable-
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care-act/index.html))
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Although the percentage of uninsured individuals has decreased, policymakers
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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.

Healthcare Costs

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))

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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/))

Social Barriers

Addressing issues related to the socio-economic conditions in America’s

communities can help improve the overall health of individuals in these
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populations. ((AHIP (America’s Health Insurance Plans), “4 Issues Shaping
Healthcare Policy,” April 8, 2021: https://www.ahip.org/4-issues-shaping-
Take charge of your
health-care-policy/)) Some public health clinics and nonprofits are working to
own wellness
provide life-storycounseling and other services to people beyond just medical
needs. This includes access to healthy food, affordable housing, transportation,
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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))

Pursuing a Career in Healthcare Policy

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If you’re interested in helping shape the future of our healthcare system, below
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The Role of Healthcare Policy Analysts

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.

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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.

The Role of Nurse Practitioners

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
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advocacy. You can also earn a role specialty as a family nurse practitioner.

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Healthcare policy is important on a macro and micro level. It affects our whole
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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.

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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.
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*The FNP track includes two required hands-on clinical intensives as part of the
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**The Nurse Educator role specialty is not available for the DNP program.
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