NHS FPX 6008 Assessment 3 Business Case for Change

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Slide 1:

Hello everyone, this is megan. I would like to thank you for your presence and patience. My topic of presentation is the business case for change. 

Slide 2: 

Introduction 

Healthcare in the US is largely dependent on insurance companies, and with the rising prices of medication and healthcare, maintaining the quality of care out of one’s pocket has become one of the most challenging tasks. Therefore, insurance companies play a significant role in ensuring the quality of care. The high cost of healthcare has become a burden on U.S. families, and the cost of healthcare has contributed largely to decisions about insurance coverage and care provision (Kearney et al., 2022).

However, the cost of the insurance also causes financial worry, as either the installment is too much or the care provided is inadequate. Surveys have highlighted that around 43% of working adults had inadequate insurance in 2022, while 9% were uninsured and had a gap in coverage over the past year up to 11%, or either were underinsured, meaning that their coverage didn’t provide them with access to care (23%) (The Commonwealth Fund, 2022).

Slide 3: 

Impact on healthcare:

The insurance issue is one of the most significant issues impacting the healthcare system, as we all know that insurance is one of the most frequently used ways to manage the cost of healthcare expenses. Therefore, its impact on my work as a nurse, my colleagues, the organization, and the overall community is interlinked and complex. 

First of all, it impacts our work as nurses and healthcare providers, as insurance issues directly impact the work of nurses, doctors. The nurses respond to changes in the regulation and financing of healthcare with innovation and responsibility. Thus, my job is to help the client get healthcare within the limits of the insurance while influencing how it is viewed. The constant struggle of making the reading policies provide interventions within the limits of their standards of care as most time is invested in navigating the insurance policies and providing the quality of care with constrained resources and options that the insurance covers (Rudman, et al.,2020). Also, it leads to occupational stress and burnout from providing care when I have to refuse patients their right to care due to financial constraints.

When the insurance doesn’t cover the patient’s full care, the organization or the patient must pay for it, which can put a strain on the organization’s finances. sources that could affect the company’s care (Laprise, 2023).  The organization struggles with insurance companies’ reimbursement rates and policies that don’t match its reimbursement rate, which affects its financial stability. This low insurance company reimbursement rate may cause economic difficulties and layoffs (Turale, & Kunaviktikul, 2019). When a health care issue occurs in society or the healthcare sector, it endures in the community, like how insurance coverage influences access to care. Due to insurance companies inability to cover their medical expenditures, older people often decline healthcare facilities.

Slide 4: 

Feasibility and Cost- Benefit Considerations

The feasibility refers to the practicality and viability of implementing the insurance plan, which includes several factors such as healthcare insurance size and the nature of the organization, financial resources, insurance coverage details, and the requirement for the regulation of insurance. However, the cost and benefit analysis provides a unique yet practical picture of healthcare insurance. It involves comparing the cost and benefits of the insurance, such as the deductibles, payment methods, administration expenses, and insurance coverage. While the benefit includes the medical service plan, medication, preventive care, and financial protections. The selection of the insurance is strictly based on the weight the benefits have against the costs.

Slide 5 

Ways to mitigate

1. Risk management is an important aspect of the implementation of insurance to mitigate the potential risk to financial security for the organization. Risk management allows the organization to identify and assess multiple risks, such as changes in the regulatory processes, changes in the market dynamics, and unexpected medical causes. Along with that, it helps in managing the insurance available and the coverage policies to ensure that the organization has insurance coverage. Similarly, it helps protect the pa