Healthcare providers are expected to do no harm and provide care at patients’ best interest. However, over the past 150 years, health care has become more of a business, than a public service. The access to, the cost of, and quality of health care has gone in the wrong direction. I have a Medical Director that gets bonuses from all 5’s Press Ganey surveys telling the Risk Management Director that leaving peripheral IV accesses for patients that are going to be directly admitted into hospitals via private car from our Immediate Care Centers should have that option as a patient satisfier. Even though, our legal department stands against it as a patient safety issue. Medicine and technology has evolved so much that organizations are challenged to sustain the expensive equipment, training to handle the equipment, etc. That is a result of many factors including the variability of charges.“In the Dallas market, a knee replacement could cost between $16,772 and $61,585 (267% cost variation) depending on the hospital” (Salmond, S. & Echevarria, M., 2017). Instead of, focusing on expensive ways to cure diseases, a shift is needed for much more reasonable focus on prevention of diseases. Nursing has a critical contribution in healthcare reform and the demands for a safe, quality, patient-centered, accessible, and affordable healthcare system and require a new or enhanced skill set on wellness and population care, with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.

The ultimate goals of healthcare reform are to increase the number of insured and to increase the quality of care while trying to stabilize or reduce costs.  People are suffering from chronic disease conditions and their costs.  The number of the people with chronic disease and death rates are increasing each year (Medical Mutual, 2017). Most of the risk factors of these chronic conditions are preventable.  Studies show that disease prevention can effectively reduce health care spending.  If the health care system concentrates on prevention and wellness programs it could substantially reduce the incidence of chronic disease, contribute to healthier lives and save money spent on treatment.  A recent study indicates that just a one percent reduction in adult smoking rates could result in 30,000 fewer heart attacks, 16,000 fewer strokes and save more than $1.5 billion over five years (Democratic Policy Committee, 2009).  Shifting our nation’s focus toward preventive health will improve the health and productivity of the people as well as in cost savings.

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