NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

Name

Capella university

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Identifying a Local Health Care Economic Issue

Hospital readmission is a core fiscal concern in health care since it has major financial and quality of care consequences. They place great pressure on the health systems, patients, and the community, contributing to high costs and poor patient outcomes. This problem affects the vulnerable population most at risk of adverse outcomes after discharge, including the elderly and patients with chronic diseases. This paper discusses the economic consequences of hospital readmissions concerning Detroit residents and the causes of this problem. It also expands on the implications of this matter to organizations and the healthcare workforce, identifying the contributing gaps.

Hospital Readmissions and Their Impact

Hospital readmissions are more prevalent in ethnic minorities and poor areas, such as Detroit, Michigan. The challenges that the Detroit population has are pivotal of socioeconomic nature: high poverty rate of 33.8% compared to 13.4% of the average in Michigan (Barker et al., 2023) and scarce access to primary care, meaning that early discharge patients are most likely to be readmitted to the hospital. Common diseases, including diabetes, heart disease, and hypertension, are common among the residents of Detroit, and this is the main cause of readmissions. Readmission to the hospital is very expensive and puts so much pressure on the individuals.

Medicare’s Hospital Readmissions Reduction Program (HRRP) reduces up to 3% of Medicare fee-for-service from hospitals with higher readmission rates than expected (Yang et al., 2022). These penalties worsen resource scarcity in an underfunded healthcare system and limit investments in prevention and patient assistance programs. Hospital readmission has become a major concern in the low-income population since patients in these populations experience obstacles like transportation, cost of medication, and issues with health literacy that prevent early recovery. Therefore, these gaps must be addressed to enhance progress and equity in health-vulnerable groups.

The Rationale for Selecting this Healthcare Economic Issue

The decision to consider hospital readmissions as a healthcare economic problem arises from the fact that it affects almost all stakeholders, including patients, hospitals, and the entire system for sustainability. Personally, I have seen the difficulties that come with handling chronic diseases in poorly served communities. Observing patients being discharged without enough follow-up care and support, only to be brought back into the hospital because of complications that could have been prevented, has helped me understand that the problem is not isolated but cyclical. Hospital readmissions represent a complex problem that touches the sphere of healthcare and financial management. They also have incurred high costs on health care; for instance, Yang et al. (2022) note that Medicare fines hospitals for readmissions to add financial burden on facilities that are already stretched to meet the population’s demands.

Furthermore, readmissions bring to the limelight the issue of inequitable access to quality health care in areas of low economic status, transport difficulties, and illiteracy in the health sector. This issue touches on two of my values, namely equity and patient-centeredness. About this, I concur with the findings laid down in the literature that all patients, irrespective of the background of their financial status, should be provided with adequate resources to effect a complete recovery and avoid such complications as proposed by the authors of this paper (McMaughan et al., 2020). These encounters have underscored the need to fill gaps in care continuity and coordination, promote and support wellness, and educate for change regarding reducing readmissions when possible.

Effect on Work, Organization, Colleagues, and Community

I have seen hospital readmissions as a major factor causing a shift of focus in the nursing care of patients and resource management. In my practice, I meet patients who are readmitted due to avoidable factors: failure to take prescribed medication, poorly controlled chronic illnesses, or no follow-up appointments. These situations demand a lot of nursing work to balance patients and treat their disorders, which distracts from preventive work. For my organization, high readmission rates result in financial loss under Medicare’s HRRP.

These penalties are costly and limit financial resources that can be used for staff development, staff recruitment, and value-added care delivery models. My colleagues receive higher workloads because of the higher knowledge of readmitted patients, which results in staff burnout and job dissatisfaction. In addition, readmissions are unhelpful for coordination between departments as staff members need to identify deficiencies in discharge planning and follow-up measures not to experience them again (Rajput, 2024). Hospital readmissions are costly and negatively impact the affected communities, especially the less endowed ones. Socially, they contribute to increased health costs to patients and various institutions, placing pressure on underfunded systems.

NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue

Hospitals experience a reduction in their quality care provision to patients as they dedicate their resources towards managing readmissions of acute patients in communities experiencing high readmission rates. In the social domain, recurrent hospitalizations seriously affect medical patients’ lives, work, and family situations. Low-income and minorities suffer from worse disparities because they lack proper support after being discharged and have poor health literacy (Shahid et al., 2022). These consequences produce health and equity disadvantage cycles, which require specific interventions to disrupt and enhance community health.

Identification of the Contributing Gap

Lack of attention to transitions and insufficient follow-up services remain the most significant gaps in 30-day readmissions (Dhaliwal & Dang, 2024), especially for patients with complex medical conditions or low socioeconomic backgrounds. This gap is due to system factors like fragmented care processes, lack of patient education, and poor access to healthcare services that all work against patients’ capacity to manage their health after discharge. One source of information shows that an evidence-based transitional care plan reduces the risk of readmissions, including increased care coordination and patient education (Pugh et al., 2021).

The study also underlines that patients who get follow-up appointments, discharge instructions, and access to community resources have much lower readmission rates. Closing this gap will require more specific approaches, such as better discharge planning, better follow-up care, and increased investment in community health programs. It becomes crucial to eliminate this gap so that the issue of readmissions and the burden of associated costs can be addressed, not to mention the problem of inequality in access to healthcare services.

Conclusion

In conclusion, hospital readmissions are one of the key healthcare economic problems facing nations, including Detroit. This issue results from conflicts related to alterations in care coordination, poor discharge procedures, and other issues like poor accessibility to follow-up care. All these challenges place additional costs on the healthcare sector and resource utilization, especially in developing societies. Solving this problem corresponds with principles of equity and a patient-oriented approach, as well as seeking effectiveness and lower expenses.

References

Barker, E., Hu, Dr. L., Alaswad , H., Fleming, O., & Klammer, S. (2023). Detroit economic indicators report. Detroitmi.gov.https://detroitmi.gov/sites/detroitmi.localhost/files/2024-04/Q2%202023%20Economic%20Indicators%20Report.pdf

Dhaliwal, J. S., & Dang, A. K. (2024). Reducing hospital readmissions. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606114/

McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8(231), 1–9. https://doi.org/10.3389/fpubh.2020.00231

Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence based processes to prevent readmissions: More is better, a ten-site observational study. BMC Health Services Research, 21(1), 189. https://doi.org/10.1186/s12913-021-06193-x

Rajput, Dr. M. (2024). The role of nursing in reducing hospital readmissions: A review. African Journal of Biomedical Research, 27, 601–604. https://doi.org/10.53555/ajbr.v27i1s.1529

Shahid, R., Shoker, M., Chu, L. M., Frehlick, R., Ward, H., & Pahwa, P. (2022). Impact of low health literacy on patients’ health outcomes: A multicenter cohort study. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08527-9