Jan 2 2013
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Resolve to Make Health Care More Equitable in 2013

A member of the Navajo Nation, Lisa Palucci, MSN, RN, is a nurse consultant at the Centers for Medicare and Medicaid Services and a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. This post is part of the "Health Care in 2013" series.

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As the nation trudges forward in its quest to improve health care access for all Americans, I think it is essential that we continue to make progress in decreasing the health disparities and social determinant of health gaps that continue to be ignored in mainstream health policy initiatives.  Throughout the course of my PhD program at the University of New Mexico (UNM), we have had numerous opportunities to experience nursing and health policy in action by attending national conferences, meetings, and orientation programs.   To my disappointment, discussion about improving health disparities and social determinants of health are seldom a topic on the agenda.  This poses the question: Aren’t the health disparities and social determinants of health what got us to the point of an inequitable health care system in the first place?

As health care professionals we are challenged with the multiple and complex demands associated with an ever changing health care system.  However, what remain steadfast are the values, beliefs, and morals our patients, families, and communities have thrived on for many generations.  The development of a "patient-centered" approach to improve America’s health care system is a step in the right direction. Patient-centered care is defined by the Institute of Medicine (2001) as health care that establishes a partnership among practitioners, patients, and their families. When appropriate, patient-centered care ensures that decisions respect patients' wants, needs, and preferences.  Its premise is that patients have the education and support they need to make decisions and participate in their own care.  I challenge each of you to ponder: To what extent have individual patients and their communities had a voice in determining what "patient-centered" means?

All too often the "patient-centered" concept is tailored to individual consumers rather than to patients and families from tribal communities.  As an American Indian nurse, I am inspired by the progress our Tribal communities have made to improve their health care system, but we have many miles to travel and bridges to cross before we can sustain a health care infrastructure that is safe, efficient, and cost effective.

Tribal governments need to take action to identify and integrate patients, families, and community perspectives in "patient-centered" care.  American Indian/Alaska Natives have a unique opportunity to contribute to the needed changes and improvement within America’s health care system by providing their insights to support a more meaningful and relevant definition of population/community focused care.

The alignment of clinical decision making with patient’s values and beliefs will allow us to build a sustainable health care infrastructure that can accommodate and support patients who also rely on traditional practitioners for care.  Even though the Indian Self Determination and Education Assistance Act of 1975 empowered tribal governments to structure and provide their own tribal health care, we have yet to define an approach that meets the diverse needs of tribal communities.  It is my hope that through my PhD research, I will further develop the concept of ‘self-determined care’ from an American Indian perspective and identify the specific components of ‘self-determined’ health care.

It is also my hope that 2013 will bring a renewed interest in decreasing the current and long-standing gaps that contribute to health disparities and social determinants of health.  The U.S. health care system is on the edge of enormous changes that need to occur in order to meet the challenges of improving the quality of care delivered and received with a "patient-centered" approach.   I challenge each of you to initiate and plan each meeting with health disparities, health inequities and social determinants at the forefront of your health system improvement agendas.  Whether it is policy debates on health care practices or payment regulation, conducting patient satisfaction surveys, educating a new population of health care professionals…the list is endless. We must all give voice to this vital discussion and consistently contribute in order to advance improvements in America’s health care system. I choose to believe our acknowledgment of past failures with health care inequities, health disparities and social determinants of health will lead us to a sustainable and equitable health care system in the future.

Tags: Disparities, Social determinants of health, Patient-centered care, Human Capital, Nursing and Health Policy Collaborative at the University of New Mexico, Nursing, Voices from the Field, Health Care in 2013