About healthcare policies

Healthcare Regulations, Readmission, and the Budgets


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Paper topic/Hypothesis : how lack of medication regulation and readmission drive up hospital cost and cause drifts in planned budgets for hospitals.


What we mean when we talk about healthcare policies is a set of preemptive regulations established to enhance healthcare delivery. The program addresses many concerns, including but not limited to; healthcare financing, protracted care, mental health, and preventative medicine. One of the most pressing problems in the United States we must solve now is how to improve healthcare delivery. People have been able to live healthier and longer lives thanks to increased Medicare expansion in recent decades. This study intends to investigate healthcare reform and the policies from different areas of healthcare inside the United States. This review takes a look at different diseases, measures of analysis, and studies done in relation to planning and policies in reflection of mortality rates and readmission of patients in different hospitals.

Starting review

It has been suggested by Buerhaus et al. (2017) that the quality of service delivered in private practice differs significantly from the quality of healthcare provided in hospitals and other medical institutions. According to the Institute of Medicine, “almost 100,000 people in the United States die every year due to preventable medical mistakes made by medical staff, lending credence to the claims made in this research.” The paper notes that many mistakes occur due to inappropriate medicine administration, inaccurate patient identification, or erroneous surgical location (Frisina and Neri 2018). Even the smallest medical blunders would be eliminated if strict protocols were strictly adhered to.

A medication policy that promotes interdisciplinary teamwork was found to be effective in reducing drug-related difficulties. Pellegrin et al. (2016) found that geriatric patients were less likely to require hospitalization due to medication-related complications when hospital pharmacists and community pharmacists worked together to manage their medications. Integrating pharmacists into primary care and other community-based healthcare teams have been proposed by Smith et al. (2016) to boost practice efficiency, care coordination, patient outcomes, and the prevention of avoidable adverse medication events. , being admitted to the hospital when they did not need to be, etc.

Bucknall et al. (2019) find that patients’ preferences on their medication management should be assessed at the time of hospital admission, even though patients’ perspectives on their involvement in medication management differ. According to research, comprehensive medication management (CMM) has been shown to help clinical pharmacists become more self-aware of how they might influence drug outcomes (Walker, 2015). Despite the fact that numerous studies have demonstrated the critical nature of drug management, medication mistakes continue to be a major issue in the United States. (Jones and Treiber, 2018).

Medication safety can be enhanced in several ways; one such way is through increased collaboration between healthcare providers, patients, and community and hospital physicians. Medication management is only one of many processes that can benefit from applying the Lean Six Sigma methodology (Nayar et al., 2016). It can be used to implement solutions such as identifying and implementing the Nurses’ Rights of medicines (at the right dose, Right medicine, Right patient, via the right route, and during the right time) to formalize as well as legitimize caregiver control over through the administration process and to establish a fair culture concerning medication surroundings (Jones & Treiber, 2018).

Measures of analysis

In measuring the hospital administration’s success and failures of policies and procedures, this research is based on the mortality and readmission rates. According to Waydhas (2020), mortality rates are the rate of death in a particular population. Readmission rates are the rate of people being readmitted to a facility with the same illness, lack of comprehensive care, and not fully recovering based on services offered. These two measures of analysis can help determine the effectiveness of administration planning and policies in offering health services to such a population.

According to Upadhyay (2019), study follows 98 hospitals in Washington State from 2012 to 2014 to see if the publicly available readmission statistics on Hospital Compare affect the hospitals’ bottom lines. The AMI, PN, and HF readmission rates were compared to revenue per patient, costs per patient, and operating margin. An examination of 276 hospital-year observations using hospital-level fixed effects regression showed a positive correlation between reduced AMI readmission rates and operational revenues. The cost of running a hospital also rises when readmission rates are lowered. There may be a little rise in operating margin due to greater operational revenues attributable to higher PN readmission rates. Nonetheless, as readmissions persist, with greater resource use comes the potential for rising costs, which might eventually eat into profits (Allen, 2015).

Reducing avoidable hospital readmissions is promoted as a quality indicator and a cost-cutting strategy (O’Connor, 2021). The Hospital Readmission Reduction Program (HRRP) was launched in 2012 as part of the Affordable Care Act (ACA). Hospitals with 30-day readmission rates for heart attack, heart failure, or pneumonia greater than planned are subject to financial penalties under this program (Upadhyay, 2019).

Although some trauma patients survive hospitalization, most of those who die do so while receiving emergency or intensive care (ICU). Yet many people do not make it past the initial hospital stay, even after being released from the intensive care unit. Initial impressions can label these incidents as “failure to rescue” victims who could have been saved. There is some speculation that a low incidence of this phenomenon in intensive care units and surgical wards indicates high-quality trauma care.

Therefore, the first step in recognizing inefficiencies of this kind and developing corrective policies is the identification and measurement of inappropriate treatment (Park et al., 2017). Consider the importance of assigning a monetary value to the health benefits of a treatment to ascertain whether or not the action in question is suitable and cost-effective.


Upadhyay’s (2019) results showed that a medical condition’s mortality and readmission rates varied, indicating that the quality of care also varied. Admin policy and practices play a crucial role in ensuring that the utmost is gained from the decisions made, not resulting in increased mortality and readmission rates. Improving care safety and health outcomes for patients requires looking at how we treat them while they are in the hospital, preparing them for life after discharge, and supporting them in the community once they return home.

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