Healthcare Program-Policy Evaluation Analysis Template
Student’s Name:
| Healthcare Program/Policy Evaluation |
Medicaid Health Program |
| Description | Medicaid is a public health insurance program that provides health coverage to Americans of low socioeconomic status. This program also covers people living with disabilities, children, and pregnant women. Medicaid is a federal and state program funded jointly by both levels of government. Individual states operate their own Medicaid programs but with adherence to the guidelines stated by the federal government. States maintain flexibility in the design of their programs due to the broader scope of the guidelines stated by the federal government. Medicaid currently provides insurance for over 70 million Americans. |
| How was the success of the program or policy measured?
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The Medicaid program was established to enhance access to care for people with low incomes. The success of this program is measured by looking at the number of persons enrolled in the program. Since its establishment, Medicaid has provided insurance coverage for tens of millions of Americans. Preliminary data indicates that as of November 2021, enrollment in the Medicaid program grew to 85 million (“Policy Basics – Introduction to Medicaid”, 2020). Medicaid has significantly increased access to care for individuals of low income.
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| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?
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Over 85 million Americans are enrolled in the Medicaid program. These individuals are mostly of low socioeconomic status and were previously troubled by the high cost of healthcare. Children have been the major beneficiaries of this program, accounting for more than 40% of the total Medicaid enrollment. This program has also benefited people with disabilities and adults with low incomes. The impact of the Medicaid program has been evident in increasing these individuals’ access to healthcare. Previous data suggest that access and equity healthcare were major attributing factors to high mortality rates among Americans from low socioeconomic status. Individuals from these groups were poverty-stricken, had no insurance coverage, and had little or no access to healthcare. These individuals were majorly from racial and ethnic minority populations (Joynt Maddox et al., 2019). Since the establishment of Medicaid, access to care has considerably improved with insurance coverage expansion among individuals from these communities.
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| At what point in program implementation was the program or policy evaluation conducted?
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The Medicaid program was established in 1965. 1n 1982, the Healthcare Financing Administration funded a Medicaid evaluation program. This evaluation process was a multi-year task piloted in six states. Evaluation of the Medicaid program was initiated in the backdrop of escalating healthcare costs and a soaring outlay of the Medicaid and mediocre programs (Freund et al., 2017). Additionally, this evaluation process was necessitated by the innovation of new healthcare management costs and the need to integrate them into the conventional stream of care. |
| What data was used to conduct the program or policy evaluation?
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The Medicaid evaluation process utilized multiple data sources. Both secondary and primary sources of data were utilized to explore critical issues on the outlay of the Medicaid program. The main areas from which data were drawn include healthcare costs, quality of care under the Medicaid program, utilization or consumption of the Medicaid program by the population under review, access to care, enrollment from the Medicaid program, and the level of satisfaction from the enrollees. The primary sources of data used included case study information, medical chart abstractions, and a survey of Medicaid beneficiaries. Secondary sources included data on eligibility and claims, Medicaid Management Information systems, and administrative cost reports.
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| What specific information on unintended consequences was identified?
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Evaluation findings revealed some ambiguity regarding the utilization and cost of care when establishing the Medicaid program. Previously, it was thought that Medicaid programs would significantly lower the cost of healthcare. However, the interpretation of low cost differed and depended on the viewpoint of the cost parameters. From the federal and state point of view, lowering the cost of payments will significantly reduce the overall cost of care for the population. However, from the providers’ point of view, lowered costs may result in reduced efficiencies of care provision and thus lower the quality of care (Freund et al., 2017). Ultimately, this may lead to hospital readmissions and consequently increase the net cost of care.
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| What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
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Stakeholders identified in the evaluation process necessary for the program’s success include healthcare providers, the American population, federal and state governments, and other insurance providers. The largest beneficiaries of the evaluation program are the providers and the state and federal governments. The evaluation program highlighted care areas that are impacted by the insurance policy. Areas such as the cost of care, accessibility, and quality of care were fairly exploited during the evaluation process (Freund et al., 2017). Information on the cost of care informed governments to increase healthcare spending on the program. Information on cost and quality of care informed the providers to offer quality care to prevent readmissions, which, in turn, increases the net cost of care. |
| Did the program or policy meet the original intent and objectives? Why or why not?
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The objective of the evaluation program was to provide an in-depth understanding of the program’s administrative costs, implementation and operational issues, cost of care, and quality of care. The program adequately answered all the questions asked in the objectives. Evaluation findings give insight into the administrative cost of the program, implementation, and operational issues, as well as information on the quality of care under the program (Freund et al., 2017). It also gives information on the cost of care and rate setting.
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| Would you recommend implementing this program or policy in your place of work? Why or why not?
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I would therefore recommend its implementation at my workplace. The Medicaid program has enabled many Americans to have access to healthcare. Its target group is persons with low incomes. It also ensured healthcare equity by enhancing access to care for persons from ethnic and racial minorities who would otherwise not have gotten access to care. |
| Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.
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Nurses maintain a central role in the healthcare provision system. Nurses can play a role in monitoring the outcomes of any healthcare policy or program. Their position in healthcare provision grants them an opportunity to monitor and record various outcomes of any interventions (Hungerford et al., 2017). Nurses can also play a role in interpreting the outcomes of any healthcare program. Nursing knowledge and expertise give nurses the skills necessary to effectively interpret and outcome any intervention. |
| General Notes/Comments | Nurses play a significant role in evaluating various healthcare policies and programs. Their position in healthcare provision accords them with the expertise and skills necessary to undertake such programs. Health programs such as the Medicaid program have impacted the American population positively. Its benefits of enhancing care coverage for low-income persons underpin its necessity.
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References
Freund, D. A., Rossiter, L. F., Fox, P. D., Meyer, J. A., Hurley, R. E., Carey, T. S., & Paul, J. E. (1989). Evaluation of the Medicaid competition demonstrations. Health care financing review, 11(2), 81–97.
Hungerford, C., Prosser, B., & Davey, R. (2017). The Key Role of Nurse Researchers in the Evaluation of Nurse Practitioner Models of Practice. Research and Theory for Nursing Practice, 29(3), 214-225. https://doi.org/10.1891/1541-6577.29.3.214
Joynt Maddox, K., Bauchner, H., & Fontanarosa, P. (2019). US Health Policy—2020 and Beyond. JAMA, 321(17), 1670. https://doi.org/10.1001/jama.2019.3451
Policy Basics – Introduction to Medicaid. Cbpp.org. (2020). Retrieved 28 April 2022, from https://www.cbpp.org/sites/default/files/atoms/files/policybasics-medicaid_0.pdf.
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Question 
Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
Select an existing healthcare program or policy evaluation, or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
Healthcare Program-Policy Evaluation Analysis Template
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
Describe the healthcare program or policy outcomes.
How was the success of the program or policy measured?
How many people were reached by the program or policy selected?
How much of an impact was realized with the program or policy selected?
At what point in program implementation was the program or policy evaluation conducted?
What data was used to conduct the program or policy evaluation?
What specific information on unintended consequences was identified?
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
Did the program or policy meet the original intent and objectives? Why or why not?
Would you recommend implementing this program or policy in your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
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