Ethical and Policy Issues Affecting Coordination of Care


Different governmental policies and nursing codes of ethics affect the coordination of care through the regulation of various sectors of care. They can have both positive as well as negative impacts on care coordination. For instance, the previous research discusses how the Health Information Portability and Accountability Act (HIPAA) improves and hinders the provision of high-quality treatment (Qin, 2020). On the one hand, it is mentioned that HIPAA protects patients’ private information and ensures that it is shared in a secure manner (Qin, 2020). On the other hand, it is argued that the document creates barriers to comprehensive healthcare provision as doctors often need to consider some background information concerning the psychological, family, and social background, which is not readily shared (Qin, 2020). In a similar vein, while the Affordable Care Act (ACA) provided access to the healthcare system for many U.S. citizens, it is argued that the law generally did not have a great impact on the quality of care (Center et al., 2017). However, despite some drawbacks, health and safety-related policies are important instruments to ensure the effective functioning of the medical system.

Four Ways Governmental Policies Affect Healthcare Coordination

There are generally four ways in which governmental policies can affect the coordination of care. Firstly, public policies help to create and distribute scarce healthcare resources (Pellegrin, 2017). Secondly, they establish legal provisions that protect and promote people’s rights in this sphere. Moreover, governmental policies institutionalize the methods of direct financial and non-financial support for medical institutions and citizens. Finally, they create opportunities and incentives for current and future professionals in terms of career choice and development.

Nursing Code of Ethics

Nurses are patients’ advocates that ensure chronic-ill patients that deliberately organize patient care activities and share relevant information with the patients. The nursing code of ethics governs nurses’ practices to enhance their capacity to impart positive health outcomes and patient satisfaction. Beneficence, non-maleficence, justice, and autonomy are the four main ethical principles in nursing critical to addressing advanced care planning and coordination (Haddad & Geiger, 2018). Other than behavioral guidelines, ethical issues have legal implications. Nurses need to strike a balance between professional responsibility and accountability. Informing patients about nursing ethics in coordinated care will create healthcare awareness and expectations.

Impacts of Nursing Code of Ethics

Through individual and collective efforts nurses improve the ethical environment of the work setting by leveraging nursing ethics. This is achieved through the wholeness of character and integrity, maintaining competence, and continuous personal and professional growth. The nursing code of ethics reduces moral distress since it serves as a guide for nurses. Additionally, the codes increase nurses’ commitment to society by clarifying their roles, and responsibilities within their profession. Ethics are a cornerstone in the healthcare profession to make informed consent, protect patient privacy and confidentiality, and enhance patient inclusivity in decision-making.

Healthcare Policies and Ethical Dilemma

Nurses should use those principles to guide them during practice also because several national, state, and local level policies are associated with an ethical dilemma. For example, policies such as the Death with Dignity Act ratified in Washington D. C. or the lack of policies that address active euthanasia cause harsh debates. In particular, from the healthcare coordinator’s perspective, many argue that active euthanasia is against a medical professional’s code of ethics (Gómez-Vírseda, 2020). Another set of policies refers to regulating whether, at what stage, where, and when women can be allowed to get an abortion. In this regard, every healthcare provider should decide whether professional and personal ethical norms and religious beliefs are not in contradiction with these practices.

Healthcare Policies in Coordinated Care

The government proposes principles of action in healthcare aimed at improving healthcare delivery and outcomes. The ACA and HIPAA are policies that regulate the cost and privacy in Medicare respectively. Both policies seek to eliminate healthcare disparity by improving access, and monitoring insurance costs whereas HIPAA protects the privacy of patient’s medical information.

Health Care Policy: The ACA and HIPAA

The ACA is an example of a healthcare policy aimed at reforming the private insurance market. Before the implementation of ACA, there were many uninsured Americans and disparity in American healthcare due to economic reasons. The ACA enhances inclusivity in medical insurance, extends Medicaid to the poor working class, and influences medical decisions. The ACA mandates insurance purchases to the populations that cannot afford it through government support on incentives. Since the challenge of access to care persists, there is the dilemma or ethical question of whether ACA provides a chance for medical insurance companies or it appreciates poor people. HIPAA ensures the privacy of patient’s health information in particular electronic records. Moreover, it improves the portability of health insurance and simplifies the administration of medical facilities.

How ACA and HIPAA Policies Affect Care Coordination and Continuum

Additionally, the ACA intends to improve medical coverage among all populations. The law subsidizes health insurance through premium tax credits targeted at lowering medical costs for households ranked between 100% and 400% of the federal poverty level (Antonisse, 2020). The ACA, therefore, improves all the social determinants of health by eliminating inequities. On the other hand, HIPAA improves the management of patient’s health information during the coordination of care. HIPAA has substantially digitized the American healthcare system to improve coordination and the continuum of care.

Social Determinants of Health

At their core, the policies discussed above primarily seek to address the socially-determined healthcare barriers. According to Healthy People 2020, “Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (n.d., para. 5). In this regard, the most important factors that contribute to the improvement of medical services quality include lack of education concerning healthy lifestyle, financial instability or poverty, access to healthcare, access to healthy food, exposure to violence and crime, and various forms of discrimination. For example, Tickamyer and colleagues (2017) discovered that there is a direct connection between rural poverty in the U.S. and people’s health outcomes in rural areas. Healthy People 2020 divides those variables into five groups, namely economic stability, education, health and healthcare, neighborhood and built environment, and social and community context (n.d.). Thus, to achieve better quality healthcare provision for all people, the project emphasizes the importance of improvement in each of the abovementioned spheres.


Overall, healthcare coordination is affected by ethical and policy issues. They can have both positive and negative impacts on healthcare provision. Moreover, some policies such as those addressing the problems of abortion and euthanasia can raise significant ethical dilemmas. To successfully address ethical problems, beneficence, non-maleficence, justice, and autonomy are the four ethical principles that nurses should uphold for appropriate conduct when delivering health care. Nurses should act in patients’ best interests and demonstrate fairness and equality to enhance the patient experience. The government implements policies that propose principles of action to improve health outcomes. One such policy is the ACA and HIPAA which oversight the reduction of insurance premiums, an increase of medical insurance coverage, and protection of patients’ confidential information.


Antonisse, L., Garfield, R., Rudowitz, R., & Artiga, S. (2018). The effects of Medicaid expansion under the ACA: Updated findings from a literature review.

Center, H., Woods, C. A., Manchikanti, L., & Purdue Pharma, L. P. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few. Pain Physician, 20, 111-138.

Gómez-Vírseda, C. (2020). John Keown: Euthanasia, ethics and public policy: an argument against legalisation. Theoretical Medicine and Bioethics, 41(1), 61-66.

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations.

Healthy People 2020. (n.d.). Social determinants of health. Web.

Pellegrin, M. (2017). 5 ways public policy impacts health. The Sycamore Institute.

Qin, F. (2020). The Debilitating Scope of Care Coordination Under HIPAA. North Carolina Law Review, 98 (6), 1395-1445.

Tickamyer, A. R., Sherman, J., & Warlick, J. L. (Eds.). (2017). Rural poverty in the United States. Columbia University Press.

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