NAPNAP position statement

. NAPNAP Position Statement

W HEALTH CARE REFORM FOR CHILDREN

The National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) strives to enhance the quality of health care for infants, children, and adolescents. Children are the nation’s most valuable resource, and NAPNAP believes that they need access to health care regardless of race, economic status, or religious beliefs. NAPNAP is concerned that many children do not have health insurance and/or access to necessary health care services (U.S. Dept. of Health & Human Services, 199 1). The following are recommendations to improve access to health care for children in the United States. Preventive Services

NAPNAP believes that the health care system should incorporate changes that focus on the promotion of health and the prevention of disease. The current emphasis, which places priority on the treatment of disease, should therefore be modified. Preventive health care includes those activities that actively promote responsible behavior and the adoption of healthy lifestyles. Prevention is the best opportunity to reduce the increasing economic resources spent to treat preventable illness and functional impairments. The promotion of health through behavior changes will keep America’s children healthier and enable financial and social resources to be used more wisely. Standard Health Benefits

NAPNAP believes children and young adults should receive the following health care services: . Prenatal care Routine office visits at recommended intervals Additional care and guidance for the pregnant adolescent Nutrition counseling Childbirth education and lactation consultation Parenting and health education Genetic counseling, as appropriate l Well child care J PEDIATR

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Routine office visits at recommended intervals for all children, birth through 21 years Individualized anticipatory guidance related to expected health and development Promotion of breast feeding for infants Routine immunizations and tuberculosis screening Growth and development assessments Screening and evaluation of hearing, vision, and speech Diagnostic health and development services as needed Reproductive health care and family planning services Laboratory screening and diagnostic services as appropriate to practice setting Rehabilitation Services Physical therapy Occupational therapy Speech therapy Prescription medications Dental care Vision care Mental health services Evaluation of children and families Counseling for children and families Social services as necessary Health education/teaching Parenting skills Growth and development concerns Nutritional needs and dietary modifications Lifestyle and habits counseling To encourage maximal health potential For chronic disease and/or handicapping conditions such as asthma or diabetes Prevention of child abuse and other forms of violence Injury prevention Emphasis on Primary Health Care

“Optimally, primary care includes the following elements: first contact care, comprehensive care, coordinated or integrated care, and care that is longitudinal over time rather than episodic. First contact care is the extent to which a patient contacts the source of care whenever he or she perceives a new need for care. CoJOURNAL

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Journal of Pediatric September-October

Health Care

Policy & Position

1993

ordination of care entails a health care provider’s ability to provide for continuity of information within their practice settings as well as with any subspecialty referral. Longitudinality of care refers to the extent to which a provider serves as a source of care over time regardless of the presence of a particular type of problem” (U.S. Congress, 1991). NAPNAP believes that primary care must be incorporated as a basic construct into the health care system and made available to children and families. Primary health care services provide a way of ensuring a comprehensive array of support services across the health care spectrum. In addition to clinics and health care provider offices, primary care sites may include such places as the workplace, schools, churches, and mobile units. It is also understood that primary care may continue in tertiary care centers. A primary health care system allows clients to become more informed about their health care and provides for increased participation and better health care management. A primary health care system increases the proportion of people who receive complete sets of essential preventive services at recommended intervals, thereby emphasizing the importance of a coordinated and holistic approach to preventive primary care. Emphasis on Primary Health Care Providers

Nurse practitioners (NPs) are primary health care providers. Primary health care providers are necessary partners in the maintenance of good health, the treatment of minor acute illness, and the management of stable chronic illness conditions. NPs play an important role in identifying individuals at risk for conditions for which interventions aimed at prevention are appropriate, that is patient education, counseling, and screening services. In many areas of the country, accessto primary care is limited by an inadequate supply of primary care providers. Overspecialization and maldistribution of physicians combined with practice restrictions placed on nonphysician providers, such as NPs, are factors contributing to this inadequate number of primary care providers. Significant changes in federal and state health care delivery laws and regulations are needed to insure that policies, including the appropriate reimbursement for service, encourage appropriate utilization of NPs as primary health care providers. Flexibility

The health care system must be flexible enough to enable each community, locality, region, or state to meet its own unique health care needs. The system should allow for new models of health care to be tested and used as appropriate. NAPNAP believes that as yet no single program exists that would meet the needs of every com-

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munity. To provide efficient health care, the system must allow for flexibility in the laws and regulations governing new programs of health care delivery. As an example, various agencies have successfully arranged health care delivery sites at schools. Other agencies have provided mobile vans to deliver health care at diverse sites. Cost Effectiveness/Cost

Containment

Incentives and emphasis should be given to the production of scientific data that will be used to determine appropriate, cost-effective health care services and treatment modalities. Outcome research that determines effectiveness from both a health and fiscal perspectives should be encouraged. The delivery of health care by hospitals and providers should be included in this research. Streamlining and reducing administrative costs and/or the use of multiple testing procedures will also decrease the cost of health care delivery. The use of uniform standard health care forms and electronic billing are to be encouraged as cost-control measures. Incentives should be given to health care delivery programs that save or contain health care costs without sacrificing the quality of care provided. The use of managed care, case management, utilization review, and coordinated care programs should be encouraged. Health maintenance organizations (Hh4Os) and preferred provider organizations (PPOs) are frequently used by employers to control costs and improve access to primary care. Malpractice

Reform

The threat of malpractice and liability litigation with its accompanying financial and emotional impacts have contributed to escalating health care costs. The practice of “defensive medicine” by health care providers to reduce this threat has been estimated to be as high as $50 billion each year. Additionally, the increasing cost of malpractice/liability insurance inflates the cost of health care and ultimately reduces the availability of some types of health care. Changes should be encouraged in laws and the civil judicial system, which will reform the malpractice/liability tort laws. This can be done by enacting limits on the awards for punitive damages, that is pain and suffering non-economic damage. Limiting collateral payments by health and disability insurers, requiring that large awards be paid over long periods of time, and curbing attorneys’ fees are other changes that will decrease the utilization of defensive medical testing. The development and use of practice standards and guidelines that are national in scope are also encouraged as a method to decrease the unnecessary use of diagnostic procedures.

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Policy

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Nondiscriminatory, of Insurance

Statement

Portability,

and Transferability

New health care models and delivery systems must provide for access to health care and/or insurance coverage for those currently uninsured. The availability of health insurance coverage for small employers is advocated as is the renewability of coverage and the continuous coverage for individuals and families when the wage earner changes employment. Health care plans that use preexisting clauses for designated diseases must be eliminated. Summary

This position statement outlines what NAPNAP believes to be the “bottom line” elements of child health

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care that must be incorporated into any health care reform proposal. NAPNAP’s focus on the optimal physical, mental, emotional, and social health of the nation’s children encourages them to grow and develop to their fullest potential. Adopted April 1993. REFERENCES U.S.

Department of Health &Human Services. (1991). Child health USA ‘91. HRS-M-CH-91-1, p. 41. Washington, DC: Author. U.S. Congress, Office of Technology Assessment. (1991, April). Adolescent health-volume I; summary and policy options. OTA-H468. Washington DC: Author.