Policy & Politics in Nursing and Health Care
Seventh Edition Diana J. Mason, PhD, RN, FAAN
Rudin Professor of Nursing Co-Director of the Center for Health, Media, and Policy
School of Nursing Hunter College
City University of New York New York, New York
Deborah B. Gardner, PhD, RN, FAAN, FNAP Health Policy and Leadership Consultant, LLC
Honolulu, Hawaii Freida Hopkins Outlaw, PhD, RN, FAAN
Adjunct Professor Peabody College of Education
Vanderbilt University Nashville, Tennessee
Eileen T. O’Grady, PhD, NP, RN Nurse Practitioner and Wellness Coach
McLean, Virginia
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Table of Contents
Cover image
Title page
Copyright
About the Editors
Contributors
Reviewers
Foreword
Preface
What’s New in the Seventh Edition?
Using the Seventh Edition
Acknowledgments Unit 1 Introduction to Policy and Politics in Nursing and Health Care
Chapter 1 Frameworks for Action in Policy and Politics
Upstream Factors
Nursing and Health Policy
Reforming Health Care
Nurses as Leaders in Health Care Reform
Policy and the Policy Process
Forces That Shape Health Policy
The Framework for Action
Spheres of Influence
Health
Health and Social Policy
Health Systems and Social Determinants of Health
Nursing Essentials
Policy and Political Competence
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Discussion Questions
References
Online Resources
Chapter 2 An Historical Perspective on Policy, Politics, and Nursing
“Not Enough to be a Messenger”
Bringing Together the Past for the Present: What We Learned From History
Conclusion
Discussion Questions
References
Online Resources
Chapter 3 Advocacy in Nursing and Health Care
The Definition of Advocacy
The Nurse as Patient Advocate
Consumerism, Feminism, and Professionalization of Nursing: the Emergence of Patients’ Rights Advocacy
Philosophical Models of Nursing Advocacy
Advocacy Outside the Clinical Setting
Barriers to Successful Advocacy
Summary
Discussion Questions
References
Online Resources
Chapter 4 Learning the Ropes of Policy and Politics
Political Consciousness-Raising and Awareness: the “Aha” Moment
Getting Started
The Role of Mentoring
Educational Opportunities
Applying Your Political, Policy, Advocacy, and Activism Skills
Political Competencies
Changing Policy at the Workplace Through Shared Governance
Discussion Questions
References
Online Resources
Chapter 5 Taking Action: How I Learned the Ropes of Policy and Politics Mentors, Passion, and Curiosity
Chapter 6 A Primer on Political Philosophy
Political Philosophy
The State
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Gender and Race in Political Philosophy
The Welfare State
Political Philosophy and the Welfare State: Implications for Nurses
Discussion Questions
References
Online Resources
Chapter 7 The Policy Process Health Policy and Politics
Unique Aspects of U.S. Policymaking
Conceptual Basis for Policymaking
Bringing Nursing Competence Into the Policymaking Process
Conclusion
Discussion Questions
References
Online Resources
Chapter 8 Health Policy Brief: Improving Care Transitions Improving Care Transitions: Better Coordination of Patient Transfers among Care Sites and the Community Could Save Money and Improve the Quality of Care1
References
Online Resources
Chapter 9 Political Analysis and Strategies What is Political Analysis?
Political Strategies
Discussion Questions
References
Online Resources
Chapter 10 Communication and Conflict Management in Health Policy
Understanding Conflict
The Process of Conversations
Listening, Asserting, and Inquiring Skills
Conclusion
Discussion Questions
References
Online Resources
Chapter 11 Research as a Political and Policy Tool
So What is Policy?
What is Research When It Comes to Policy?
The Chemistry between Research and Policymaking
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Using Research to Create, Inform, and Shape Policy
Research and Political Will
Research: Not Just for Journals
Discussion Questions
References
Online Resources
Chapter 12 Health Services Research: Translating Research into Policy Defining Health Services Research
HSR Methods
Quantitative Methods and Data Sets
Qualitative Methods
Professional Training in Health Services Research
Competencies
Fellowships and Training Grants
Loan Repayment Programs
Dissemination and Translation of Research Into Policy
Discussion Questions
References
Online Resources
Chapter 13 Using Research to Advance Health and Social Policies for Children
Research on Early Brain Development
Research on Social Determinants of Health and Health Disparities
Advancing Children’s Mental Health Using Research to Inform Policy
Research on Child Well-Being Indicators
Research on “Framing the Problem”
Gaps in Linking Research and Social Policies for Children
Nursing Advocacy
Discussion Questions
References
Online Resources
Chapter 14 Using the Power of Media to Influence Health Policy and Politics
Seismic Shift in Media: One-to-Many and Many-to-Many
The Power of Media
Who Controls the Media?
Getting on the Public’s Agenda
Media as a Health Promotion Tool
Focus on Reporting
Effective Use of Media
Analyzing Media
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Responding to the Media
Conclusion
Discussion Questions
References
Online Resources
Chapter 15 Health Policy, Politics, and Professional Ethics
The Ethics of Influencing Policy
Reflective Practice: Pants on Fire
Discussion Questions
Professional Ethics
Reflective Practice: Foundational Nursing Documents
Personal Questions
Reflective Practice: Negotiating Conflicts between Personal Integrity and Professional Responsibilities
Personal Question
U.S. Health Care Reform
Reflective Practice: Accepting the Challenge
Personal Question
Reflective Practice: the Medicaid 5% Commitment—an Appeal to Professionalism
Discussion Question
Reflective Practice: Your State Turned Down Medicaid Expansion
Personal Question
Reflective Practice: Barriers to the Treatment of Mental Illness
Personal Question
Ethics and Work Environment Policies
Mandatory Flu Vaccination: the Good of the Patient Versus Personal Choice
Conclusion
Discussion Questions
References
Online Resources
Unit 2 Health Care Delivery and Financing
Chapter 16 The Changing United States Health Care System Overview of the U.S. Health Care System
Public Health
Transforming Health Care Through Technology
Health Status and Trends
Challenges for the U.S. Health Care System
Health Care Reform
Opportunities and Challenges for Nursing
Discussion Questions
References
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Online Resources
Chapter 17 A Primer on Health Economics of Nursing and Health Policy
Cost-Effectiveness of Nursing Services
Impact of Health Reform on Nursing Economics
Discussion Questions
References
Chapter 18 Financing Health Care in the United States
Historical Perspectives on Health Care Financing
Government Programs
The Private Health Insurance and Delivery Systems
The Problem of Continually Rising Health Care Costs
The ACA and Health Care Costs
Discussion Questions
References
Online Resources
Chapter 19 The Affordable Care Act: Historical Context and an Introduction to the State of Health Care in the United States
Historical, Political, and Legal Context
Content of the Affordable Care Act
Impact on Nursing Profession: Direct and Indirect
Overall Cost of the Aca
Political and Implementation Challenges
Conclusion
Discussion Questions
References
Online Resources
Chapter 20 Health Insurance Exchanges: Expanding Access to Health Care
What is a Health Insurance Exchange?
Exchange Purchasers
Other Health Insurance Options
Federal or State Exchanges
State-Based EXCHANGES
Development of the Exchanges
Establishing State Exchanges
The Federal Exchange Rollout: ACA Setback
New York’s Success Story
The Oregon Story
Exchange Features
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Marketplace Insurance Categories
Role of Medicaid
Nurses’ Roles with Exchanges
Consumer Education
State Requirements Include Aprns in Exchange Plans
Assessing the Impact of the Exchanges and Future Projections
Conclusion
Discussion Questions
References
Online Resources
Chapter 21 Patient Engagement and Public Policy: Emerging New Paradigms and Roles Patient Engagement Within Nursing
Patient Engagement and Federal Initiatives
The VA System: an Exemplar of Patient-Centered Care
From Patient Engagement to Citizen Health
Conclusion
Discussion Questions
References
Online Resources
Chapter 22 The Marinated Mind: Why Overuse Is an Epidemic and How to Reduce It
Commonly Overused Interventions
Reasons for Overuse
Financial Incentives as the Major Cause of Overuse
The Marinated Mind
Physician and Nurse Acknowledgment of Overuse
Public Reporting to Reduce Overuse
Journalists Advocate for More Transparency About Overuse
Discussion Questions
References
Online Resources
Chapter 23 Policy Approaches to Address Health Disparities
Health Equity and Access
Policy Approaches to Address Health Disparities
Evaluating Patient-Centered Care
Summary
Discussion Questions
References
Online Resources
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Chapter 24 Achieving Mental Health Parity
Historical Struggle to Achieve Mental Health Parity
Implications for Nursing: Mental Health Related Issues and Strategies
Discussion Questions
References
Online Resources
Chapter 25 Breaking the Social Security Glass Ceiling: A Proposal to Modernize Women’s Benefits1 Benefits for Women
Strengthening the Program
Changes We Oppose
Strengthening Financing
Discussion Questions
References
Online Resources
Chapter 26 The Politics of the Pharmaceutical Industry
Globalization Concerns
Values Conflict
Direct to Consumer Marketing
Conflict of Interest
Education
Gifts
Samples
Conclusion
Discussion Questions
References
Online Resources
Chapter 27 Women’s Reproductive Health Policy
When Women’s Reproductive Health Needs are Not Met
Why Do We Need Policy Specifically Directed at Women?
Women’s Health and U.S. Policy
Discussion Questions
References
Online Resources
Chapter 28 Public Health: Promoting the Health of Populations and Communities
The State of Public Health and the Public’s Health
Impact of Social Determinants and Disparities on Health
Major Threats to Public Health
Challenges Faced by Governmental Public Health
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Charting a Bright Future for Public Health
Discussion Questions
References
Online Resources
Chapter 29 Taking Action: Blazing a Trail…and the Bumps Along the Way—A Public Health Nurse as a Health Officer
Getting the Job: More Difficult Than You Might Think
Creating Access to Public Health Care in West New York
On-the-Job Training
Political Challenges
Safe Kid Day Arrives
Nurses Shaping Policy in Local Government
Successes and Challenges
References
Chapter 30 The Politics and Policy of Disaster Response and Public Health Emergency Preparedness
Purpose Statement
Background and Significance
Presidential Declarations of Disaster and the Stafford Act
Policy Change After September 11
The Politics Underlying Disaster and Public Health Emergency Policy
The Homeland Security Act
Project Bioshield 2004
Pkemra 2006 and Disaster Case Management
National Commission on Children and Disasters 2009
Threat Level System of the U.S. Department of Homeland Security
Conclusion
Discussion Questions
References
Online Resources
Chapter 31 Chronic Care Policy: Medical Homes and Primary Care
The Experience of Chronic Care in the United States
Medical Homes
The Role of Nursing in Medical Homes
Patient-Centered Medical Homes: the Future
Discussion Questions
References
Online Resources
Chapter 32 Family Caregiving and Social Policy
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Who are the Family Caregivers?
Unpaid Value of Family Caregiving
Caregiving as a Stressful Business
Supporting Family Caregivers
Discussion Questions
References
Online Resources
Chapter 33 Community Health Centers: Successful Advocacy for Expanding Health Care Access
Community Health Centers Demonstrate the Advocacy Process for Innovation
The Creation of the Neighborhood Health Center Program
Program Survival and Institutionalization
Continuing Policy Advocacy
The Expansion of Community Health Centers Under a Conservative President
Community Health Centers in the Era of Obamacare
Discussion Questions
References
Online Resources
Chapter 34 Filling the Gaps: Retail Health Care Clinics and Nurse-Managed Health Centers
Retail Health Clinics
Access and Quality in Retail Clinics
Retail Clinics and Cost
Challenges and Reactions to the Model
Nurse-Managed Health Clinics
Future Directions for Retail Clinics and NMHCs
Discussion Questions
References
Online Resources
Chapter 35 Developing Families The Need for Improvement
Social Determinants and Life Course Model
Innovative Models of Care
Health Care Reform
Barriers to Sustaining, Spreading, and Scaling-Up Models
Conclusion
Discussion Questions
References
Online Resources
Chapter 36 Dual Eligibles: Issues and Innovations
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Who are the Duals?
What are the Challenges?
Health Care Delivery Reforms That Hold Promise
Implication for Nurses
Policy Implications
Discussion Questions
References
Online Resources
Chapter 37 Home Care and Hospice: Evolving Policy
Defining the Home Care Industry
Home Health
Hospice
Home Medical Equipment
Home Infusion Pharmacy
Private Duty
Reimbursement and Reimbursement Reform
Hospital Use and Readmissions and the Focus on Care Transitions
Quality and Outcome Management
The Impact of Technology on Home Care
Championing Home Care and Hospice and the Role of Nurses
Discussion Questions
References
Online Resources
Chapter 38 Long-Term Services and Supports Policy Issues
Poor Quality of Care
Weak Enforcement
Inadequate Staffing Levels
Corporate Ownership
Financial Accountability
Other Issues
Home and Community-Based Services
Public Financing
Conclusion
Discussion Questions
References
Online Resources
Chapter 39 The United States Military and Veterans Administration Health Systems: Contemporary Overview and Policy Challenges
The MHS and VHA Budgets
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Advanced Nursing Education and Career Progression
Contemporary Policy Issues Involving MHS and VHA Nurses
Post-Deployment Health-Related Needs
References
Seamless Transition
Conclusion
Discussion Questions
References
Online Resources
Unit 3 Policy and Politics in the Government
Chapter 40 Contemporary Issues in Government Contemporary Issues in Government
The Central Budget Story
Fiscal Policy and Political Extremism
How Will the Nation’s Economic Health be Addressed?
The Impact of Political Dysfunction
Polarization
Loss of Congressional Moderates
Gerrymandering
Congressional Gridlock: Where is the President’s Power?
Beleaguered Health Care Reform
Implementation Challenges
Increasing Access
Affordable Care Act Costs and Savings
Legal Challenges to the ACA
Immigration Reform: Will Health Care be Included?
Current Health Care Access
The Ethics and Economics of Access
Immigration Health Care Reform Options
Rising Economic Inequality
Measuring Wealth
The Great Recession Reshaped the Economy
Costs of Economic Inequality
Impact of Economic Inequality on Health Equity
Effectively Addressing Economic Inequality
Proposed Policy Strategies
Climate Change: Impacting Global Health
Climate Change: It’s Happening
Mitigation Versus Adaptation
International Progress
Adaptation is Local
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Examples of Health in All Policies
Nursing Action Oriented Leadership
Conclusion
Discussion Questions
References
Chapter 41 How Government Works: What You Need to Know to Influence the Process
Federalism: Multiple Levels of Responsibility
The Federal Government
State Governments
Local Government
Target the Appropriate Level of Government
Pulling It All Together: Covering Long-Term Care
Discussion Questions
References
Online Resources
Chapter 42 Is There a Nurse in the House? The Nurses in the U.S. Congress The Nurses in Congress
Evaluating the Work of the Nurses Serving in Congress
Political Perspective
Interest Group Ratings
Campaign Financing
Sources of Campaign Funds
References
Online Resources
Chapter 43 An Overview of Legislation and Regulation
Influencing the Legislative Process
Regulatory Process
Discussion Questions
References
Online Resources
Chapter 44 Lobbying Policymakers: Individual and Collective Strategies
Lobbyists, Advocates, and the Policymaking Process
Lobbyist or Advocate?
Why Lobby?
Steps in Effective Lobbying
How Should You Lobby?
Collective Strategies
Discussion Questions
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References
Online Resources
Chapter 45 Taking Action: An Insider’s View of Lobbying Getting Started
Winds of Change Coming in State Legislatures
Political Strategies
There Really is a Need for Lobbyists
Chapter 46 The American Voter and the Electoral Process Voting Law: Getting the Voters to the Polls
Calls for Reform
Voting Behavior
Answering to the Constituency
Congressional Districts
Involvement in Campaigns
Campaign Finance Law
Types of Elections
The Morning After: Keeping Connected to Politicians
Discussion Questions
References
Online Resources
Chapter 47 Political Activity: Different Rules for Government-Employed Nurses
Why Was the Hatch Act Necessary?
Hatch Act Enforcement
Penalties for Hatch Act Violations
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