Question 1The cost containment of healthcare is an important one, particularly in the United States where rising costs have not also resulted in better patient outcomes. In 2012 the cost of healthcare for Americans was nearly $3 trillion dollars, representing almost 20% of all spending (Emanuel et al., 2012). There are at least four ways in which nurses can reduce healthcare costs while still maintaining holistic care, and these include ensuring the application of the most effective treatments, ensuring proper documentation of all treatments and status reports, reporting on administrative processes that do not serve health status of patients or outcomes, and advocating for appropriate staffing levels of nurses.
Ensuring the application of the most effective treatments is one where nurses can show leadership by staying up-to-date on research and the translation of research into practice in the area of nursing (Blair, 2015).
Ensuring proper documentation of all treatments and status reports is another area where nurses can contribute to lowered healthcare costs, particularly the costs of redundant treatments and tests (Nykänen et al., 2012). Evaluation of the national nursing model and four nursing documentation systems in Finland–Lessons learned and directions for the future. International journal of medical informatics, 81(8), 507-520.
Reporting on administrative processes that do not serve the health status or outcomes of patients is another area where nurses are able to contribute to cost containment. In many cases nurses are frustrated in efforts to treat patients due to administrative delays in approvals or other areas, and this can create preventable complications which are due to postponed care.
Nursing has impacts on patient care as well as costs, and at least one study showed that increasing the volume of nursing hours by one hour per nurse per day led to a nearly 9% drop in pneumonia (Cho et al., 2003).
Each of these areas shows just one way that nurses can help to contain the costs of healthcare. Many of the causes of these costs are structural or beyond the scope of responsibility of an individual nurse, such as staffing levels, and this can be a source of frustration.
Question 2
Healthcare costs, including the costs of appropriate insurance, can often be unaffordable for Americans. On the other hand, many Americans further escalate the costs of their healthcare by engaging in unhealthy lifestyles. It can be difficult to find a balance between the idea of healthcare as a human right and ethical responsibility and the level of care and resources needed to provide it. While it can be noble to wish and hope for free, quality healthcare for all individuals, given that the provision of that care requires labor, equipment, physical structures and buildings, administration, research and other resources, it is not realistic to assume that healthcare can be provided to all for free. Further, the patients also have a responsibility to contribute to the costs of healthcare as well as maintaining their health.
There are many stakeholders in the American healthcare system, and ultimately everyone pays. One pays as an individual whether to insurance companies or to healthcare providers; business owners pay through health insurance contributions in some cases, and in other cases they pay when the health of an employee, and productivity, suffers. Taxes contribute to healthcare costs of Medicaid and Medicare. While there are many different circumstances, all pay in some way for the costs of healthcare in the US.
While on the balance, statistically, a patient who works hard to make healthy lifestyle choices should also have better health outcomes, and this is the best way to contain spiraling health costs- through personal responsibility for health. Currently many health insurance plans penalize those who engage in unhealthy or risky lifestyle choices such as smoking, however there are few rewards or benefits for those who work hard to maintain their health.

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    References
  • Blair, K. A. (2015). Evidence Based Practice: Staying Informed and Translating Research into Practice and Policy. Advanced Practice Nursing: Core Concepts for Professional Role Development, 243.
  • Cho, S. H., Ketefian, S., Barkauskas, V. H., & Smith, D. G. (2003). The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nursing research, 52(2), 71-79.
  • Emanuel, E., Tanden, N., Altman, S., Armstrong, S., Berwick, D., de Brantes, F., … & Spiro, T. (2012). A systemic approach to containing health care spending. New England Journal of Medicine, 367(10), 949-954.
  • Nykänen, P., Kaipio, J., & Kuusisto, A. (2012). Evaluation of the national nursing model and four nursing documentation systems in Finland–Lessons learned and directions for the future. International journal of medical informatics, 81(8), 507-520.