What Is Healthcare Policy


Health care is a fundamental human need. Individuals require clinical intervention to recover from injuries and illnesses across cultures, and communities benefit from the promotion of basic wellness practices and disease prevention. These efforts, aimed at achieving common goals, are classified as health policy.

But what exactly is healthcare policy? It is defined by the World Health Organization (WHO) as “decisions, plans, and actions taken to achieve specific health care goals within a society.” This broad category can be subdivided into specific policies, such as those concerning mental health care and healthcare affordability. Below is an article to help you expound on these questionnaires and issues.

What Exactly Is Healthcare Policy?

Health policy can be defined as a set of overarching principles and goals that govern how care is delivered and accessed. Health care policy can be codified at the national or state level before being fine-tuned in a hospital or clinical setting.

The Value of Healthcare Policy

Health policy is aspirational, which means it is intended to show health providers the kinds of outcomes they should strive for. According to WHO, health policy “defines a future vision, which in turn helps to establish targets and points of reference for the short and medium-term.”

Furthermore, health policy clarifies priorities by establishing roles and expectations for various groups, such as doctors, nurses, and administrators. It also aids in the formation of consensus among the various participants in a community or a health system.

New Legislation and Regulations

Requirements for healthcare, state laws, and regulations, CMS Conditions of Participation, Joint Commission Standards, and other accreditation requirements are required. This makes it difficult to ensure that proper policies are not only developed but also effectively communicated to employees. As a result, the legacy policy management systems used to maintain policies are no longer viable and may endanger the organization. It is difficult to keep up with every new law or regulation update, let alone ensure policies and procedures are effectively rolled out to employees.

With the rapid pace of new and updated laws and regulations that providers must address, it can be difficult to ensure that policies and procedures are up to date, accessible, and effectively communicated throughout the organization. This is where more cutting-edge policy management software can help.

Using Technology in Education

To manage their healthcare policies and procedures, the best healthcare organizations must use both technology and education. Technology solutions play a critical role in streamlining this process.

It can aid in the provision of a controlled framework for updating, authorizing, and communicating with the organization, as well as ensuring that older policies are properly archived and not disseminated in a way that could negatively impact patient care. Because regulations change at such a rapid pace, automated policy approval and dissemination, as well as employee access recognition, are required.

We have worked with a number of large healthcare providers that rely heavily on a web-based policy management system for policies and procedures. Based on our research, this is an excellent method for reaching out to employees not only locally, but also those who may be located off-site. This is especially true for those who work in more remote and isolated areas.

Policy management systems that allow for streamlined updating and notification tools to keep employees informed of changes are essential. It is also critical to make it simple to view documents and communicate changes throughout an organization.

The Best Healthcare Policy and Procedure Software

The best policy management software solutions will ensure that employees have easy access to that information and can communicate changes in regulations that affect those policies to managers and stakeholders. Furthermore, effective policy management systems can help ensure that an organization’s policy and procedure information is up to date and accurate. This gives regulatory and accrediting organizations a more effective way to validate that you are operating in a state of continuous readiness for a survey or audit. Inadequate sound systems can lead to additional on-site visits by these bodies, putting the organization at risk of increased deficiencies and penalties.

Policy in the healthcare setting lays the groundwork for providing the highest level of care. In today’s environment, in order to achieve optimal efficiencies, healthcare organizations must combine sound organizational processes with complementary technology.

When it comes to policies and procedures, we are firm believers in adhering to rules and regulations. As a result, we strive to create solutions that assist in doing so while also keeping healthcare facilities on track. If you’d like to learn more about our healthcare policy management solution, please contact us. We would be happy to discuss how policy management software can help you organize your policies and procedures.

It’s possible that our software is exactly what your company needs, or that another vendor has a better offering. In any case, we’d be happy to point you in the right direction; please don’t hesitate to contact us. Alternatively, if you’d like to see our software in action, please request a free demonstration.

Different Types of Health Policies

Health policy can be divided into several categories, each of which addresses a different aspect of health care. Some primary examples are as follows:

•         International health

Global health looks at the big picture, assessing the health needs of people all over the world and striving for equity of care.

•         Community health

Policies enacted on a national, state, or community level to promote healthy lifestyles and prevent the spread of infectious diseases are referred to as public health policies.

•         Pharmaceuticals

Pharmaceutical product regulation, availability, and affordability may be addressed by health policy.

•         Financing

Health policy can influence how care is paid for, including how much the state reimburses health facilities for their services.

•         Mental well-being

Mental health care is an important consideration when developing health policy, as it provides goals and objectives for promoting mental well-being and treating those who have mental health conditions.

•         Equity in health

Many health policies state that they want to make sure that care is distributed fairly across communities and demographics.

•         Insurance

Health policy may also govern the role of insurance in financing care, promote affordable or public insurance options, and limit what insurers can and cannot do.

•         Medical services

The codification of a health policy will have an immediate impact on the types of health care services available in a given area.

Health Practitioners’ Role in Health Policy

Nurse practitioners have a significant impact on health policy. Nurse practitioners, in particular, implement health policies and have the ability to influence health care systems and organizations to improve patient health outcomes. Because nurse practitioners are on the front lines of care, it is frequently their responsibility to translate big-picture health policies and procedures into one-on-one patient interactions.

Nurse practitioners are important in health policy development because they spend a lot of time interacting with patients and learning about their needs. As a result, nurse practitioners generally have a good understanding of what works and what doesn’t. They can communicate successes and limitations to policymakers, allowing them to fine-tune health policy accordingly.

Nurse leaders are frequently responsible for communicating health policy to the nursing team members who report to them, as well as holding those nurses accountable to stated goals and expectations. Some specific ways in which nurse practitioners can influence health policy are as follows:

  • Examining existing policies for inefficiencies, missing components, or opportunities to improve care delivery or affordability
  • Developing new policies in response to needs encountered in daily practice
  • Providing clinical insight into policy proposals by meeting with policymakers, administrators, and lobbyists.

Developing Skills for Incorporating Health Policy

Depending on their practice specialty, nurse practitioners can have a variety of effects on health policy. Consider the following examples:

  • A family nurse practitioner sees patients of all ages and can advise on how health policy can make care more accessible to families from diverse demographic and socioeconomic backgrounds.
  • Because an adult-gerontology primary care nurse practitioner has more experience caring for older adults, they can speak more specifically about disease prevention and wellness promotion in this community.
  • A psychiatric mental health nurse practitioner can discuss how current health policies promote or degrade mental wellness in their patients.

Nurse practitioners must have a strong educational background in their specialty in order to effectively implement health policy and advocate for positive changes. An important course in the curriculum is Ethical, Legal, and Health Policy Issues, which provides critical frameworks for analyzing and influencing policy at all levels. The right education is critical for nurse practitioners who want to understand and influence health policy.

The goal of healthcare policy and procedures

The goal of healthcare policy and procedures is to provide consistency in day-to-day operational activities. We have learned over the years that policies and procedures are critical in providing clarity when dealing with issues and activities that are critical to health and safety, legal liabilities, and regulatory requirements.

The significance of healthcare policies and procedures cannot be overstated, but how they are best managed varies from organization to organization. We thought it would be useful to share our knowledge on policies and procedures manuals because their importance may not be as obvious as it should be.

To that end, we strive to create powerful solutions that assist in the management of policies and other documents in order to improve the productivity and efficiency of a healthcare facility while also ensuring that it does not violate any regulations. With that said, we recognize that we may not be a good fit for every organization and that another vendor may be a better fit.

Policy in healthcare is critical because it establishes a general plan of action to guide desired outcomes and serves as a fundamental guideline to help make decisions. The goal of healthcare policy and procedures is to communicate to employees the organization’s desired outcomes. They assist employees in understanding their organizational roles and responsibilities. In the healthcare environment, policy should lay the groundwork for the delivery of safe, cost-effective quality care.

With the continued addition of new regulations and requirements, such as the Affordable Care Act, HIPAA, and Meaningful Use, the burden of developing policies and effectively communicating them to employees has grown.

Health policy and risk management

Risk Management and Healthcare Policy is a peer-reviewed, open-access international journal that focuses on all aspects of public health, policy, and preventative measures to promote good health and reduce morbidity and mortality in the population. The journal’s specific topics include:

  • Community and public health policy and legislation Healthcare that is preventative and predictive Management of risks and hazards Epidemiology,
  • surveillance,
  • screening Changes in lifestyle and diet Programs for disease transmission/modification and vaccination Health and safety,
  • occupational health and safety Provision of healthcare services Health education
  • literacy Health-related advertising and promotion Evaluations of health economics
  • resource management Human interventional and observational research is the focus of Risk Management and Healthcare Policy.
  • Original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary,
  • extended reports are all welcome. Case reports will be considered only if they make a significant and unique contribution to the literature.

New legislation

President Barack Obama signed the Affordable Care Act into law in 2010. The law’s goal was to provide health insurance to all Americans while also reducing healthcare spending and costs. The reforms primarily affect the insurance industry and have been implemented gradually since the law’s passage in 2010.

Proponents of the reforms claim they will reduce costs and improve access to healthcare, while opponents claim the legislation will raise costs and reduce the quality of care. The law has been subjected to a number of legal challenges, and according to a Kaiser Family Foundation poll conducted in July 2015, 78 percent of Americans believe the law will be challenged in the future.

The effects of the law’s reforms are uncertain and will be closely monitored over the next several years due to the complexity and size of the healthcare industry, which accounts for one-sixth of all spending in the country, and the political disputes surrounding it. This page is about healthcare policy in general; to learn more about the effects of the Affordable Care Act, please visit this page.

Healthcare policy entails the development and implementation of laws, rules, and regulations to govern the nation’s healthcare system. The healthcare system consists of medical professionals providing services to diagnose, treat, and prevent mental and physical illness and injury. The system also includes many related industries, such as insurance, pharmaceuticals, and health information technology.


In the United States, how is healthcare delivered?

The healthcare system in the United States is primarily a third-party payer system, which means that a health insurance plan (the third party) reimburses doctors for the majority of the cost of healthcare services provided to patients.

The country employed a hybrid system of public and private insurance. Medicaid, for low-income people and people with disabilities, and Medicare, for people 65 and older or younger people with certain disabilities or kidney disease, are the two major public programs. The majority of Americans, 48%, have private health insurance through their employer. The remaining insured individuals either purchase private insurance through the individual market or receive insurance through another publicly-funded program, such as the military’s TRICARE.

What can be done to improve healthcare?

There are several paths that could be taken that could have an impact on federal healthcare policy. Healthcare laws can primarily be changed through the legislative process, in which Congress passes legislation and the president signs it.

The federal government could, for example, change some of the provisions of the Affordable Care Act or repeal it entirely in this manner. Another way to influence healthcare policy is through the regulatory process, in which federal agencies write rules for how laws are implemented.

Administrative action could also have an impact on healthcare. For example, a Republican administration may be more likely to approve state proposals to expand Medicaid through an alternative method rejected by the Obama administration.

Finally, lawsuits could have an impact on healthcare through the court system. For example, the federal government could withdraw its appeal in House v. Burwell, which would end insurer reimbursements for lowering costs for low-income customers.

Importance of Legislation

Beginning in the mid-twentieth century, the federal government began to play a larger role in regulating the healthcare industry. The National Institutes of Health and the Centers for Disease Control, as well as the Food and Drug Administration and the Department of Health and Human Services, were established at the time. During the second half of the twentieth century, the federal government also enacted a number of pieces of legislation aimed at expanding insurance coverage and controlling costs:

  • The 1965 Social Security Amendments, which established Medicare and Medicaid
  • The Health Maintenance Organization Act of 1973, promoted health maintenance organizations (HMOs) as an alternative to fee-for-service plans.
  • The Consolidated Omnibus Budget Reconciliation Act of 1985, allowed employees who would otherwise lose their healthcare coverage to keep it (due to job loss, medical leave, etc.)
  • The Health Insurance Portability and Accountability Act of 1996, limited insurance companies’ ability to exclude people with preexisting conditions.
  • The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, created health insurance exchanges and mandated that all citizens obtain health insurance.

Despite repeated calls for a national health insurance program since the early 1900s, no such legislation has been enacted in the United States.

Healthcare policy is critical at both the macro and micro levels. It has an impact on our entire society, as well as each community and facility where care is provided. If you want to make a difference in healthcare and be an advocate for change.

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