How to write a nursing Policy Analysis Paper (Solved)

How to write a nursing Policy Analysis Paper (Solved)

Health policy is important because it shapes the entire healthcare landscape, including both patients and providers. It is best understood to represent the principles and goals dictating how care is delivered and accessed (Liu & Brook, 2017). Healthcare policy helps to define a vision for the future of healthcare and establishes targets for providers. Innovation in healthcare policy has emerged to address issues that make the delivery and access of care difficult. This strategy identifies new health policies, products, systems, and technologies that can be implemented to meet the diverse needs of populations. These innovations have resulted in more convenient, effective, and less expensive treatments. This discussion focuses on innovative health policy reforms in the United States and the impact on the health of populations.

Vermont’s Single Payer System

The elimination of health disparities, achievement of health equity, and improvement of healthcare access appear to be key goals for the US healthcare system. Despite the efforts to provide quality care and improve patient outcomes, there exist gaps in healthcare access, especially among underprivileged communities. Inconsistent implementation of healthcare policies like the Affordable Care Act (ACA) greatly contributes to the observed challenges (McDonough, 2015). Currently, the United States has a multipayer system where healthcare finance is controlled by different insurance companies around the nation. In 2011, Vermont took a different approach in pushing for a public healthcare system that could utilize the single-payer system to improve efficiency.

A single-payer system is a healthcare system adopted by many countries and involves one entity collecting all fees and paying for all healthcare costs. This system is observed to minimize waste by allowing a few entities to control finances (Arnold, 2012). During the build-up of the Vermont Single-payer system, it was observed that commercial insurance was the largest financing agency in the country. The 2018 Vermont Household Health Insurance Survey (VHHIS) found that 97% of the people in the State were insured. Of this population, 53% had private insurance, 19% had medicare and 22% were under the Medicaid program (The University of Vermont., 2021). There were significant differences observed in the number of insured individuals and the utilization of their plans. The availability of multiple insurance plans from different entities also was observed to hinder the balance of healthcare expenditure. As a result, 3.7% of the population experienced difficulties in accessing healthcare services and those utilizing private insurance complained of various inefficiencies.

The Vermont single-payer healthcare policy was enacted to address the issue of cost and lack of insurance in the State. In an interview, Allan Ramsay, one of the five board members overseeing the legislation noted that almost $5 billion of the healthcare budget came from public money (Ankuda, 2012). To address this issue, cutting back on reimbursements to the physicians was necessary. Additionally, Ramsay explained that despite commercial insurance being the largest financer of the US healthcare system, the actual percentage of capital going directly to primary care services was low. The creation of the single-payer system could address the issue of reimbursements affecting the State and design private insurance that could finance the entire state (Ankuda, 2012). The system could address the issue of doctors and hospitals submitting their bills to thousands of different health insurance companies around the nation. The single-payer system could reduce the time spent handling insurance claims and address the competition between insurance companies that hinder quality service delivery.

Adoption of Vermont’s Single Payer System

The adoption of Vermont’s single-payer system can be explained in a series of steps following the passage of the Affordable Care Act (ACA) in 2010. ACA was passed in March 2010 and it allowed for the expansion of access to insurance alongside other ways of improving healthcare delivery (The University of Vermont., 2021). The act intended to improve quality and system performance in all states and Vermont saw an improvement in the number of uninsured individuals to 3.7%.

During this period, states were given the mandate to control their healthcare systems, and Act 128 established in 2010 enabled Vermont to establish a commission to study different forms of healthcare delivery in the state. Because the state lacked expertise in this sector, Dr. William Hsiao, an advisor during the Taiwan transition to a single-payer system was consulted. As a result, the state agreed to design a public health benefit option administered by the state government (The University of Vermont., 2021). A single-payer system was proposed to be the most viable and practical plan for the state of Vermont. It was proposed that an independent board representing all the major payers could be formed and used to govern the program.

The second part of the single-payer system’s adoption involved the passage of Act 48 based on the conclusions from Hsiao’s report. The act was signed in 2011 following the election of governor Peter Shumlin into office. The bill established the Green Mountain Care Board to guide in transition into the new healthcare payment system (The University of Vermont., 2021). The board was expected to be functional by 2017 because of the federal healthcare law restricting states to set up their own systems before certain periods. In 2013, the board continued to expand on the system and proposed measures to finance it and how exchanges could be carried out. For instance, an 11% payroll tax on employers was proposed and the board would use federal health finances to fund the state program (McDonough, 2015). Overall, the single-payer system in Vermont was enacted by the state legislature in 2011. The bill was titled Single-Payer and Unified Health System and passed the House and Senate hearings with the majority of votes. The bill was signed in May 2011 by Governor Peter Shumlin and was expected to be fully functional by 2017.

Funding, Impact, and Ethical Outcomes

The effectiveness of healthcare systems is dependent on financial stability and how the funds are utilized to achieve desired outcomes. One of the key challenges faced by the Vermont single-payer system was establishing a safe payment system. Initially, it was proposed that a tax of 11% could be levied on employers and the federal government could offer additional financial support (The University of Vermont., 2021). It was proposed that by 2014, the state could receive a waiver from the federal government. Additionally, the bill provided room for private insurers to continue providing insurance depending on individual preferences.

The initial estimate for Green Mountain Care was that it could save the state $1.6 billion over 10 years (ThirdWay, 2019). The state was given until 2013 to provide a proposal on how funds could be raised but various challenges made it impossible. In 2014, the state government ran 14 financing concepts to try and create a balance between income taxes and payroll taxes. Overall, the state budget was $5.1 billion from 2012 to 2013 and was estimated to decrease years after. For example, the annual cost for 2017 was estimated to be $4.3 billion, $4.8 billion in 2019, and $5.1 billion in 2021 (ThirdWay, 2019)). The existing healthcare funding was far below the state budget and new revenue from payroll and income taxes could not provide adequate capital to run the program. It was observed that additional costs required could lead to a 4% increase in payroll taxes, or a 50% increase in income taxes (The University of Vermont., 2021). The feasibility of the financial plan became challenging and the state government could not make the numbers work leading to the failure of the payment system.

The single-payer system did not flourish in Vermont because of various factors related to the cost of healthcare delivery. The system could have had a huge impact on the amount of capital spent by the people if it had a feasible plan. The effort would have established a state-financed system to provide universal coverage and replace most commercial insurance in Vermont. The first factor that can explain the reason for the innovation’s demise is the decline of revenues from Medicaid and ACA (McDonough, 2015). Secondly, the state projected cost of the single-payer system increased due to policy choices. The elimination of state taxes on medical providers further made it difficult to raise the necessary capital for the adoption of the healthcare system. Asking the legislature to approve a new 11.5% payroll tax on employers to finance the system would have increased the state budget by 45% (McDonough, 2015). This financial impact on the economy the state politics ruin the future of the single-payer system in Vermont.

Nations must design delivery systems with improved quality and patient experience as the main goals. A single-payer system has several advantages over a multi-payer system if well-implemented. Large insurance companies benefit greatly from the capital raised by taxpayers. Physicians and hospitals are observed to submit different forms to several insurance companies and this increases waste. Hsiao explains that almost 10% of healthcare spending is based on fraud and the multi-payer system makes it difficult to detect the fraud (The University of Vermont., 2021). A single-payer system would ensure that finance is controlled by a few entities and the incorporation of private insurers into the single system could reduce healthcare spending. For example, Taiwan implemented single-payer national health insurance in 1995 and their healthcare expenditure makes up about 6.4% of the nation’s GDP compared to 18% of the US (Arnold, 2012). Likewise, Japan’s statutory healthcare system’s total healthcare expenditure is 11% of the GDP because they utilize the single-payer system (Liu & Brook, 2017). The adoption of the system in Vermont was a good step toward improving healthcare delivery, but the lack of clear policies and financial structure made it impossible to realize the dream.

Evidence-based ethics is defined as the conscientious and judicious use of the best evidence to inform decisions that affect the prognosis of patients (Markowitz & McLeod-Sordjan, 2021). Healthcare policy is based on ethical principles that ensure patients are rightfully treated. The single-payer system is an example of an innovation aimed at promoting access and health equality in Vermont. In the United States, strategically adopting the norms of health systems is the duty of the legislature and Vermont’s attempt to pass the single-payer system demonstrates ethical healthcare practice. The legislation upholds the ethical principle of justice whereby it guarantees that people can get the healthcare services they deserve. Ensuring that no harm occurs to patients through the single-payer system demonstrates upholding the ethical principle of non-maleficence (Markowitz & McLeod-Sordjan, 2021). The single-payer system in Vermont indicated that the provision of healthcare should not be determined by market forces.


Arnold, C. (2012). Vermont attempts single-payer health care. The Lancet380(9845), 873.

Ankuda, C. K. (2012). Vermont’s single-payer health care system: An interview with Allan Ramsay. AMA Journal of Ethics14(7), 567-570.

doi: 10.1001/virtualmentor.2012.14.7.pfor1-1207

Markowitz, W., & McLeod-Sordjan, R. (2021). Values-based foundation for a US single payer health system model. Frontiers in Sociology, 96.

McDonough, J. E. (2015). The demise of Vermont’s single-payer plan. New England Journal of Medicine372(17), 1584-1585.

The University of Vermont. (2021). Vermont legislative research service: Single payer healthcare systems.

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