Nurse Paper 3 Revision

Running Head: CHANGE POLICY PROPOSAL 1

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CHANGE POLICY PROPOSAL 2

Change Policy Proposal

Part A

A1. Public Policy Issue

Jacksonville is an area whose occupants have varying levels of income and hence,

some families with low income may not qualify for the Obama Care reformation also known as

the Affordable Care Act. However, people belonging to a low economic class have the right to

accessing primary care at a lower cost or even free of charge. It is important to note that lack of

insurance cover and low income are two main factors that decreases control of personal health

care as well as increases morbidity in low income earners. My proposal is centered at

development of free clinic to offer healthcare services to individuals with no or low income.

A1a Issue Selection

Based on the America health care policy, everyone has a right to access healthcare

services (Jones & Kantarjian 2015). The right to access health care is supported by the fact that

even the emergency departments may not fail to provide the needed healthcare services to

patients regardless of their economic status. However, individuals with low income and also

who do not have health insurance coverage may not receive the medical services for a long

period. For instance, an individual with an emergency case of high blood pressure may receive

some emergency medical attention but the services may not be extended to prevent future

occurrences of high blood pressure. The proposal of free clinics is to help patients with low

income who may not afford the Obama Care because it is only favorable to fewer individuals.

Having such clinics in place is important because they support increased patient well-being as

well as reducing morbidity and hospital admissions.

CHANGE POLICY PROPOSAL 3

A1b. Issue Relevance

It is argued that there is at least a 35% decrease in uncompensated health care. With the

introduction of Obama Care, a significant number of people are able to access health care

services as compared to the situation before the introduction of the policy (Obama, 2016). It is

important to note that the Obama Care reformation does not include everyone on board as

individuals with no insurance still face some challenges in accessing health care services. There

is a still a big gap in meeting the health care dynamics amongst Americans.

In another study, it is argued that failure to withstand the Obama Care reformation has resulted to

individuals with low income to struggle in meeting the health care bills. It is argued that the

introduction of the new policy has discouraged some individuals from accessing continual health

care services and illness management (Kaiser, 2018). As a result, a significant number of

individuals from low economic status have been forced to depend on emergency departments as

a way to access primary care even for long term diseases.

A1c. Financial Impact

The proposed change will have a substantial financial impact. It is important to note that

provision of healthcare services is an expensive project that requires a large amount of capital.

Consequently, providing and maintaining management of long-term ailments is likely to

substantially impact the financial reserves for both the federal and state governments. The

financial impact can be perceived from three different angles. Firstly, finances are required to

set up centers and clinics for free health care services. Secondly, the clinics will also need to

have adequate medication to be offered for free to a high number of patients who do not have

medical insurance. Thirdly, more finances are also required for the salaries for the health care

CHANGE POLICY PROPOSAL 4

providers, janitors and every staff working in these free clinics. In summary, the financial impact

will be as a result of funds to cater for medications, health care providers, staff, medications and

medical supplies.

A2. Personal Values

From my personal observation, some people live in poverty because of two main reasons.

One reason is that some individuals have made the personal decision of not being employed and

hence end up lacking the funds to cater for medical care or a job to provide health care insurance

for them. Another reason for increased poverty for some individuals is because of mental and

physical illnesses that causes some kind of disability which in turn prevents them from being

able to earn income that may facilitate access to health care services. In my opinion, the

proposal for free clinic can be actualized through the pursuant of community and religious

obligatory role of helping individuals. It is the role of religious groups and community to help

individuals with low income to access health care services. Even though it appears to be

unrealistic, having the right people on board would facilitate easier achievement of free clinics as

religion plays an important role in decision making in the lives of many.

A2a. Ethical Principle or Theory

My suggestion for free clinic is guided by the ethical principle of taking care of others or

beneficence. Having free clinics will help individuals to have autonomy over basic needs,

medications and health. It is of importance because it leads to helping individuals to regain

dignity, despite suffering from different forms of illness. It is also important to realize that

helping the individual from a lower economic class to access health care will cultivate a sense of

inclusivity where the low income earners and individuals without income are treated equally like

members of society, instead of looking down on them and writing them off as low-lives. Even

CHANGE POLICY PROPOSAL 5

more, it is an approach that help the health care providers to have a positive impact on the

society by offering help.

Part B

B1. Decision Maker

The decision maker who needs to receive the briefing policy is Lenny Curry, the Mayor

of Jacksonville.

B1a. Explanation

It is important to seek the decision maker’s attention concerning the policy change. The

decision maker, the mayor of Jacksonville plays an important role in influencing the

implementation of different policies including the health care policy. The role of the decision

maker is critical for the implementation of the free clinics which will help to meet the emerging

needs of patients. There is an increasing number of individuals who do not have funds to access

health care services following the introduction of The Affordable Care Act. It is estimated that

approximately 31 million individuals in the United States do not have medical insurance. Hence,

making it difficult to access the health care services (VIM, 2014). This group of individuals

without healthcare insurance comprises of undocumented immigrants and other Americans with

low income who cannot afford to pay for any time of plans for medical insurance. According to

Andrews (2016), some individuals who are suffering from long term illness causes a higher

deduction for their medical insurance which may be as high as $1000. Consequently, even

though some individuals may be working, the high deductions towards medical insurance may

prevent them from seeking medical help not including the out-of-pocket deductions.

Importantly, the other reason that calls for seeking the decision maker’s attention is due

to the gap in the health care policy. It is important to note that large sums of funds are being used

CHANGE POLICY PROPOSAL 6

to meet the needs of hospitals providing care to individuals with health care insurance with little

consideration to the individuals with low incomes and without medical insurance cover.

Involving the decision maker will help to create a balance in between treatment for insured and

uninsured patients. For instance, we can save more funds used in hospitals. This can be achieved

by having less specialized care providers attend to patients with minor healthcare needs. This

strategy can help shift some funds towards helping in the implementation of the free clinics. The

decision maker’s influence is also essential in ensuring improved access to primary care and

decreased spending in healthcare services (Salmond & Echevarria, 2017).

B2. Challenges

The proposal to have free clinics is an important idea that will facilitate access to

healthcare facilities for individuals without medical insurance coverage. However, starting and

implementing the free clinics initiative is likely to face three major challenges.

First, there are higher chances of financial challenges. It is important to note that the

establishment of free clinics is a new policy with no previous plans. It requires high initial capital

to start and also to maintain. The large sum of money may be a challenge because it is likely to

be facilitated by donors and other philanthropic individuals in the society. Even though the

government may offer support, it is an expensive initiative because some medical needs such as

long term illness may need more money which the patients may not manage to provide in the

long run.

The initiative to make the free clinics a reality is also faced with the challenge of finding

the best place to locate the clinic. It is important to note that the individuals without medical

insurance and individuals living with in poverty are scattered in different regions. To meet the

needs of various individuals would require establishing the clinics in different regions to ensure

CHANGE POLICY PROPOSAL 7

equity in meeting the needs of individuals from different regions. Importantly, the challenge of

finding the best location also contributes to financial constraint.

Another critical challenge in implementing the free clinic is scarcity of resources. The

project requires various resources including health care providers, free medication, health care

supplies and tools such as blood pressure machines, EKG machines, Tele monitors, etc. that are

needed to diagnose and treat patients. All these resources need large sums of money, which may

result to taking longer time before the plan can be implemented. It is also important to note that

the United States health department faces a major challenge, which is the shortage of health care

providers, a factor that may further influence the implementation of free clinics. The clinics will

also need medical equipment such as imaging machines and lab equipment among others to

facilitate fully functioning of the clinic to meet the needs of different patients.

B3. Options/Interventions

The mayor may implement three decisions that will affect health care access to low

income individuals and patients without health care coverage. First, the mayor could make the

decision to allow patients without medical insurance to access healthcare services through the

emergency department. It is the easiest way through which the patients not covered by Obama

Care can access health care facilities. It is a quicker way for the low-income individuals to

receive quick treatment that can help to facilitate their health care and prevent death. However,

this is not the most effective option, and is recommended to be followed only when it is

impossible to implement the free clinics. The option is considered inappropriate in providing

sufficient care services because patients will not benefit from long-term care that they need

because the emergency department only provides care to alleviate the symptoms for a short

period.

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Another option for the decision maker is to consider taking only the affordable parts of

the proposed policy. Having realized the financial challenges associated with the project

implementation, the decision maker can ensure effectiveness by partly implementing the services

that ensures the individuals within the low-income bracket get reliable healthcare facilities. For

instance, instead of having a permanent location for the free clinics, the mayor may support

implementation of the free clinics that are mobile. This strategy will help reduce the cost of

implementing the project by reducing the number of physical clinic location. Importantly,

having a mobile clinic will help the care providers to reach a larger number of patients needing

the specialized care services. Even more, it will reduce the number of care providers required

hence, a reduction in the overall cost of implementing the free clinics.

Finally, the decision maker can also choose an option of improving the proposed

decision. Improving the proposed solution may be the best plan because it will involve

integrating the existing policy with the new policy. For instance, the mayor may influence the

inclusion of the proposed free clinic services into the existing hospitals. This may include

inclusion of the policy that facilitates access to health care by the uninsured and low-income

earners in the Affordable Care Act.

B4. Course of Action

The mayor will have a different course of action to overcome the problems. First, the

challenge of financial constraints in meeting the needs of implementing the free clinic can be

pursued by seeking financial help through government grants. The financial aid from the

government is the best option for this case because the government can provide substantial

amount that can help the in implementing the policy change through establishment of free

clinics. Secondly, the challenge of shelter and location of the free clinics can be solved by the

CHANGE POLICY PROPOSAL 9

decision maker locating low cost business locations where the clinics can be set up for reduced

fees. Even more, the decision maker can overcome the challenge of insufficient resources by

seeking aid from already existing hospitals and religious organizations in the community. For

instance, the mayor may seek donations of equipment, beds, and computers from hospitals

around. The mayor could also have staff members who work at local hospitals volunteer in the

free clinic and provide training from established hospitals on how to offer health care services to

low income individuals. It is also necessary for the decision maker to involve the State

Epidemiologist in educating the public and the target supporters about the importance of the free

clinics. It is an effective way that may help the target supporters to understand the urgency of

having the free clinics.

B5. Success of Policy

The evaluation of policy success will show the extent to which the proposed policy has

succeeded. The success of the proposed policy will be evaluated based on the approval of free

clinics to operate throughout the region. The approval will show the success of the mayor in

winning the support from religious organizations, businesses and established hospitals helping in

actualizing the proposed policy change. The evaluation of can also be achieved by observing the

trend in the number of patients admitted in the emergency rooms. It is important to note that an

advantage of the free clinic is to reducing the number of emergency visits by providing adequate

access to uninsured and low-income patients.

Part C

C1. Identified Organization or Community

The proposed organization to form collaboration with is UF Health of Jacksonville in

Florida.

CHANGE POLICY PROPOSAL 10

C1a. Summary of Expressed Interest

UF Health of Jacksonville was established in 2002 and it serves the purpose of assessing

the health care needs of community members. The aim of the organization is to bridge the gap

for patients without healthcare insurance to have access to healthcare facilities and treatment.

The organization’s purpose correlates with the proposed health care policy and the organization

collaborates with other organizations to facilitate healthcare to individuals with limited access to

healthcare.

C2. CBPR Principles

The first CBPR principle is that the free clinic is for a community. The principle

corresponds with the acknowledgement that communities are distinct and different communities

have different needs. This principle supports the fact that different patients have different needs

and it has a moral obligation to cater for the needs of all patients (Applying Principles of

Community-Based Participatory Research to Your Program, 2011). The second principle is

building on strengths and resources within the community. Establishing free clinics is a best

strategy to for utilizing the resources within the community for improving the lives of

community members. For instance, it creates a chance of utilizing the unused resources owned

by local hospitals and business organizations. The third CBPR principle is promoting co-

learning and building capacity among different partners (Applying Principles of Community-

Based Participatory Research to Your Program, 2011). The proposed policy change is critical

because it needs the collaboration between different stakeholders.

C2a. Approach and Collaboration

I can organize for collaboration by requesting a meeting with the UF Health CEO to

present my proposal. The UF Health has one clinic in operation and hence my proposed policy

CHANGE POLICY PROPOSAL 11

change will facilitate providing healthcare services to more individuals especially those living in

poverty and lack health care insurance. Even more, collaboration can be enhanced with further

meetings with the director of UF Health to find out possible ways of having staff volunteer and

donating equipment to make services available to the people in need. Importantly, the

collaboration can also be improved by discussing the objectives of the proposed policy to

establish the best way to form effective collaboration.

C2b. Goal Alignment

The goal of my proposed policy is to help individuals who have challenges accessing the

Affordable Care Act to have access to health care without insurance being a limiting factor. The

UF Health has a similar goal because it focuses on facilitating access to health care facilities and

services for individuals without health care insurance. For instance, the hospital provides

patients with a card known as Shand’s card that facilitates free stays in hospitals during

admissions and free medications that are provided by UF Health (Financial Assistance, n.d).

Therefore, it is evident that the organization’s goal and mode of operations aligns well with the

proposed policy change.

C2c. Action Steps

Achieving the goal of helping the uninsured access healthcare facilities requires strategic

approaches. Firstly, it will be necessary to invite the UF Health management to join hands in

requesting support from religious organizations and businesses to advocate toward channeling

their support in providing health care access to the uninsured and the poor. Secondly, I would

seek funds and aid from volunteers and donors who can help by donating funds and turning the

proposal into a reality. In addition, I would consider gathering resources from local businesses

CHANGE POLICY PROPOSAL 12

and the local hospitals that can help in providing health care services, donating medical supplies

and equipment.

C2d. Roles/Responsibilities

The function of the proposed free clinics will be impacted by the roles of different

individuals and groups in the community. The role of project proposer is to coordinate other

members of the team and organize meetings that will facilitate the implementation of the

proposed policy. The project proposer will also serve the purpose of being the meeting

facilitator. It is essential because it contributes to the coordination of the meeting and discussion

of agendas leading to successful policy change. The UF Health leadership will serve in

managing the staff of the free clinics as well as offer help in procuring equipment to help

facilitate the operation of the clinics. Another important group is the owner of local businesses

who will play the role of remodeling the location facilities including buildings and other

infrastructures to ensure successful launch of the free clinics. Even more, the management of

local universities such as Jacksonville University can take part in contributing towards change of

policy through permitting the nursing students and medical doctors to be part of the policy

change. For instance, the nursing students would help in educating community members about

the benefits of free clinics to the public.

C2e. Key Elements of Evaluation Plan

The evaluation plan for the proposed policy change can be evaluated by considering the

previously mentioned CBPR principles. The proposed policy will be evaluated based on the

CBPR principle of acknowledging the community by checking the extent to which services are

offered to individuals of different race without exclusions. The evaluation plan will also include

the principle of building on strengths and resources of the community. For instance, the extent

CHANGE POLICY PROPOSAL 13

of which the policy changes utilizes the religious organizations, transport programs, and food

programs within the community to enhance the delivery of services to patients. The principle of

promoting co-learning and capacity building among partners is also essential because it

contributes in development of evaluation programs that can assess the skills of workers that is

necessary in meeting the service delivery requirement.

C2f. Community/Organization Plan

The success of the organization plan could be evaluated based on the responses from the

individuals expected to offer support in actualizing the policy change. For instance, a higher

number of individuals showing up to support the proposed policy change will be an indication of

a successful plan. Even more, support from local businesses and the already established local

hospitals is an indication of acceptance from the surrounding community. The success will also

be indicated by various factors including the number of supporters attending the organized

meeting to support the policy change idea. Even more, the presense of the needed support from

the local businesses and hospitals will also indicate the acceptance level of various groups. For

instance, getting the needed financial support from the government and other donors will indicate

the will and of such organizations to see the proposed policy in operation.

Part D

D1. Strengths of Each

The top-down method makes the organization have support and approval of financial

income from the government before the proposal made public to the community. It is essential

because it helps to offset burdening the public by offering some support. On the other hand, the

bottom-up approach puts pressure on government officials and other organizations to support the

CHANGE POLICY PROPOSAL 14

proposal. It is an approach that makes the community members to feel as part of the proposed

change.

D2. Challenges of Each Approach

A significant challenge of top-down approach is the difficulty in getting the approval of

the government leadership to support the policy change. The proposed project needs large

amounts of money and the mayor maybe reluctant to approval because of uncertainty of the

support from the community. The problem with bottom-up approach is that the community may

feel disappointed if the project does not succeed. Even more, the bottom-up approach does not

guarantee the community support in pushing for approval from government leadership.

D3. Most Effective Approach

The most appropriate approach is top-down. The approach is suitable because it will

involve the government officials identifying the advantages and shortcomings of the proposed

policy before the actual implementation of the change. Even more, the approach would facilitate

collaborators such as UF Health leadership to influence the community members to volunteer

and make donations to help in actualizing the policy change.

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References

Andrews, M. (2016, April 19). For The Insured But Cash-Strapped, Free Health Clinics Still

Have A Place. Retrieved from National Public Radio:

https://www.npr.org/sections/health-shots/2016/04/19/474731301/for-the-cash-strapped-

insured-free-health-clinics-still-have-a-place

Applying Principles of Community-Based Participatory Research to Your Program. (2011,

October 1). Retrieved from Health Outreach Partners: https://outreach-

partners.org/2011/10/01/applying-principles-of-community-based-participatory-research-

to-your-program/

Financial Assistance. (n.d.). Retrieved from UF Health: https://ufhealth.org/financial-assistance

Kaiser, H. J. (2018, October 3). 2018 Employer Health Benefits Survey. Retrieved from Kiser

Family Foundation: https://www.kff.org/report-section/2018-employer-health-benefits-

survey-section-1-cost-of-health-insurance/

Obama, B. (2016). United States health care reform: progress to date and next steps. Jama,

316(5), 525-532.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for

nursing. Orthopedic nursing, 36(1), 12.

VIM. (2014, April 2). The Need for Free Clinics Under the Affordable Care Act. Retrieved from

Volunteers in Medicine: http://volunteersinmedicine.org/free-clinics-affordable-care-act/

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