FIGURE
Keeping up with changes to our health care system is enough to make your head spin. And 2003 promises more of the same. Health care costs, stabilized in the mid-1990s because of managed care, are once again climbing rapidly, straining employers, employees, and government programs. Forecasts for 2003 show that continuing stress will impact how clinicians view their professions and how they relate to one another. Hospitals, physicians, nurses, and other components of the health care system are increasingly pitted against each other. Money allocated for one clinician group threatens the allocation for other groups, adding to the "us versus them" mentality.
The cuts continue
The impending state fiscal crisis is largely due to plunging tax collections and soaring medical cost. Additionally, many cities are spending billions on new security measures without receiving any direct federal assistance. These costly anti-terror strategies are contributing nothing to promoting health care for our country's citizens. Under budgetary pressure from the recession, states must look for ways to save money. Unlike the federal government, they don't have the option of deficit spending or printing money. Consequently spending and program cuts have already begun. Huge cuts in Medicaid services are virtually unavoidable. Such cuts will seriously limit our ability to care for patients.
Medicare providers face staggering reimbursement cuts, and three competing priorities complicate Medicare administration: setting payment rates at levels high enough to ensure the participation of providers, restricting overall program expenditures, and ensuring that beneficiaries have access to health care. In addition, the movement to obtain prescriptive drug benefits for Medicare will compete with funds for clinicians.
The number of Americans without health insurance rose to 41.2 million last year. Coverage erosion from small businesses is at least partially responsible for this increase. Employers are switching from comprehensive to catastrophic coverage, requiring employees to pay costs above their substantial deductibles. Patients are increasingly responsible for a larger portion of their health care bill. When faced with large deductibles, they avoid preventive care and use expensive interventions to treat resultant serious illnesses.
Even practice perks face declines. The U.S. Department of Health and Human Services advised the pharmaceutical industry that rewards they commonly use to market and sell drugs are no longer permissible.
NPs get set
The National Academy of Sciences recently acknowledged that the US health care system is in the midst of a crisis. Possible solutions (e.g. universal insurance coverage, no-fault payment for medical malpractice) seem impossible in today's political climate. Nonetheless, in the midst of these economic stressors, APNs must stand ready for 2003. We feel the intense financial pressure to see more patients during the day, but we'll continue to find creative ways to resist diminishing our role to "midlevel medicine."
And, we must persist to eliminate the words collaboration and supervision from every statute and regulation in the country. Though frustrating and time-consuming, each time legislators open the Nurse Practice Act for revision, they become better informed of our issues. Retaining any legislative or regulatory hierarchy of physicians over NPs is a travesty against the nursing profession. The public deserves unfettered access to proven, safe, evidence-based care. States whose statutes, rules, or regulations require supervision or collaboration are sanctioning one profession's economic power over another, causing restraint of trade and diminished health care provider availability. We must keep the heat on our legislatures and stay true to our APN values. If we do, our role will emerge from 2003 strong and ready to face the next year's battles.