Relevance to the Profession of Nursing The nursing profession is greatly affected by the health care system and health insurance. Nursing can have a major effect on the issue of insurance denial by minimizing self-induced health problems through health promotion. Proper guidance through health promotion and intervention will help reduce the high numbers of self-induced health problems. Additionally, nurses play a tremendous role in being an advocate for the patient and their health. As an advocate, “the nurse helps individuals obtain what they are entitled to receive from the health care system, tries to make the system more responsive to client and community needs, and assists client in developing skills to advocate for themselves” (Edelman, 2006, p. 18). A nurse’s responsibility also includes being an educator. This involves teaching the clients how to better care for themselves, how to make healthier lifestyle choices, and how to change poor habits and implement positive ones. The Code of Ethics for Nurses, which was established by the American Nurse Association, emphasizes this role as a health promoter and educator (Chitty, 2005, p. 525). Ethics are a big priority for nurses in the twenty-first century. They provide nurses with the ability to differentiate between which actions would be right or wrong to pursue. The Code of Ethics also provides the people of our society with a written set of standards that nurses vow to follow when providing care (Chitty, 2005, p. 523). These ethics include providing our clients with the tools to make healthy decisions for their lifestyle. If the client is not making healthy choices simply because they lack the knowledge of what to do, then it is our duty as nurses to educate them. Another way insurance denial affects nurses is the actual insurance reimbursement to the facility the nurse works for. If the client comes in for treatment and is not insured due to their high risk factors, then the responsibility to repay the incurred bills fall on the hospital and community. The individuals with insurance, however, have their insurance companies reimburse the hospital for the care received and as a result the nurse and other faculty members get paid. Reimbursement is a big factor for third party payers or insurance companies and the contract that they have with the individual (Chitty, 2005, p. 422). As a result, individuals with higher health risk factors must pay higher deductibles and co-pays so that the insurance company is able to reimburse the health care facility. The factors described above greatly influence nursing care and how medical treatment is provided. As a result of the high health care costs, nurses are forced to limit their level and quality of care to clients (Chitty, 2005, p. 440). In other words, costs not only affect health insurance, but nurses and their profession as well. It is part of the nurse’s role to make sure clients receive all of the information applicable to their current situation, even if it is self-induced. Providing client care is one of the main reasons the nursing profession is utilized today. Anything that affects the patients, directly or indirectly affects the nurses who would be providing their care.Conclusion The issue of insurance denial and self-influenced health problems is a growing concern for many Americans. It directly affects the cost of everyone’s health care and health insurance. It also questions the justness of the insurance system and whether it is ethical to accept high risk individuals and raise the cost for insurance and health care for others, or deny these individuals and discriminate based on their lifestyle choices. Additionally, should each individual be responsible for their own health, or should they be allowed to rely on the health care system to care for their diseases and the consequences of their risky behaviors? Supporters for denying insurance of self-influenced health problems argue that denial of insurance to high risk individuals will lower health insurance costs and health care costs. As a result, health care and insurance will be more affordable and available for those who currently cannot pay for it. Additionally, denial of insurance coverage might motivate individuals to alter their lifestyle to improve or maintain their health. Forcing people to take incentive for their own health will result in an overall healthier population and fewer quick-fixes provided by the health care system. The argument for health coverage of high risk individuals is that it should be the right of all individuals to receive health care and insurance regardless of their lifestyle choices. Medical services to improve health should be available to all, whether or not it is for the treatment of self-induced problems. Also, the cost of not covering high risk individuals could ultimately result in a higher cost for the general population to pay if the denied individual goes without health care until the condition becomes extremely life-threatening and costly. In which case, the individual’s inability to pay the expense out-of-pocket is deferred to the hospital, further raising the cost of health care and insurance.As a group, our point of view in response to the issue is in favor of insurance denial for self-induced health problems such as smoking, obesity, heart disease, and diabetes. While we do not feel that individuals should be completely denied health insurance based on their high risk behaviors, it is appropriate for insurance companies to charge higher rates for coverage or deny coverage for services directly related to the self-influenced problem. This approach will have a positive benefit on society in terms of lowering health care costs and insurance costs. In addition, people will become more accountable for their own health maintenance. This solution will begin to improve our health care system as a whole and make services more affordable and readily available to those who currently do not have health insurance. Resolving the issue of insurance denial and self-influenced health problems is one step toward the betterment of the American health care system.
References
Barclay, L. (2005). Denial of Care Due to Alcohol Use: A Newsmaker Interview with Larry M. Gentilello, MD. Retrieved March 11, 2007, from http://www.medscape.com/viewarticle/
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Chitty, K. K. (2005). Professional Nursing: Concepts and Challenges (4th ed.). St. Louis, Missouri: Elsevier Saunders.
Flegal, K. M., Carroll, M. D., Odgen, C. L., & Johnson, C. L. (2002). Prevalance and Trends In Obesity Among US Adults, 1999-2000. Journal of American Medical Association, 288(14), p.1723-1727.
Frakes, M. A., & Evans, T. (2006). An Overview of Medicare Reimbursement Regulations for Advanced Practice Nurses. Nurs Econ, 24(2), 59-65. Retrieved March 23, 2007, from http://www.medscape.com/viewarticle/531035
Huether, S.E., & McCance, K.L. (2004). Understanding Pathophysiology (3rd ed.). St. Louis, Missouri: Mosby, Inc.
Sturm, R. (2002). The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs. Health Affairs. Retrieved March 25, 2007, from http://content.healthaffairs.org/
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Washington State Health Insurance Pool (2007). WSHIP. Retrieved March 25, 2007, from https://www.wship.org/Default.asp.
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