Hilary Clinton once said, “We need a cost-effective, high quality health care system, guaranteeing health care to all of our people as a right” There are a set of resources that govern the body of our health care delivery system. Some of the sectors of the system include protocols, standard care of delivery and policies.
Protocols are a set of rules governed by nursing practice by the state or federal level, it allows providers to maintain quality services and educate staff (Heymann, 1994). Policy is the agreement, contract, that describes all terms and conditions to meet the need of people (Mason, et al, 2017). Standard of care is a collective body of knowledge required for the nurse to know and sets minimum criteria for proficient practice (IMC, 2003).
Policies at the federal level are set to regulate and maintain on influencing nursing and nursing practice, they also determine who gets funding for specific programs, such as health research, education, and Medicare or Medicaid programs (Mason, et al, 2017). States determine their own scope of nursing practice and govern their own practice act (Mason, et al, 2017). Collectively, State and federal level determine regulations under government programs such as Medicare. In essence the resources all provide balance to the health care delivery system; Protocols, Policies, Standard delivery of care, are key to quality health care delivery.
The healthcare delivery system is responsible to deliver quality care to patients, such as hospitals, outpatient clinics, insurance plans, purchasers of health care services and independent practices (IMC, 2003). Delivery systems are either private sector, nonprofit or for profit. Perceptions of the patient, provider, payer and policy maker differ in a health care delivery system. The patient assumes to receive quality care, access to care and affordability. Providers must deliver quality health care services in efforts to maintain payments from insurers and contracted services. Payers such as insurance companies, is a business that shifts the risk of loss from an individual to a third party (Austin, 2017). Since the cost of health care has increased, there are developed plans that help Americans pay for health care services. Payers pay the provider under contract agreement. Policy makers help control and regulate government funds and create polices that meet the need of citizens. Overall, the resources of health care delivery systems maintain and address the needs of health care demands and provide patient centered care.
Our healthcare system is shaped by regulations in the form of protocols, standards of care, and policies. Protocols at the practice level constitute a set of instructions to guide patient care decisions and define specific management plans (Brunier, n.d.). Protocols at the state level define activities and set guidelines according to the states’ legislation. At the federal level, protocols relate to the national matters and negotiations. Standards of care provide definition to the nursing role and practice. These standards delineate specific guidelines to deliver care in each state, and they provide the foundation to set federal laws and regulations. CDC (2015) defines a policy as a law, regulation, procedure, administrative action, incentive, or voluntary practice. A health policy reflects the values, beliefs, and attitudes of those designing the policy, whether on the local or national stage; moreover, policies can be narrowed to the scope of a practitioner’s work responsibilities or they can be expanded to respond to the state/national guidelines or requirements for practice (Brinkmann, 2018).
Patients, providers, payers, and policy makers have different perspectives of the healthcare delivery system. While patients focus on treatment success, payers are interested in healthcare costs and coverage, providers are interested in healthcare outcomes and care provision, and policy makers deal with healthcare quality and access to care. Policymakers’ work is based on the rest of the stakeholders (patients, providers, and payers). Policymakers set the context within which the health care system operates; help establishing eligible beneficiaries and patients’ costs; maximize population health; and establish regulations regarding who can legally provide health services within their jurisdiction (Ritz, Althauser, & Wilson, 2014).
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