1

Ethical and Policy Factors in Care Coordination

Katie L. Cassady

Capella University

NURS-FPX4050: Coordinating Patient Centered Care

Erica Elkins-Little

October 2024
 2

Ethical and Policy Factors in Care Coordination

According to the American Nurses Association, the Code of Ethics for Nurses with

Interpretive Statements (The Code) was developed as a guide for carrying out nursing tasks in a

manner that conforms to the criteria for nursing care quality and the ethical responsibilities of the

profession. Specifically, for this assessment, the American Cancer Society (ACS) will be

discussed. ACS is a cancer advocacy group that strives to enhance the quality of life for cancer

patients and their loved ones. The ACS has a code of ethics of its own. According to the ACS’s

Code of Ethics, employees and associates should prioritize ethical behavior in all facets of their

work while keeping their mission to fight cancer front and center. This includes acting honorably

and morally, abiding by all society conduct and behavior policies, obeying all federal, state, and

local laws, and upholding core values like integrity, compassion, courage, determination, and

diversity in all actions and decisions.

Government Policies

A government statute called Patient Protection and Affordable Care Act (ACA) seeks to

expand the affordability and accessibility of health insurance for more Americans. In order to

improve patient outcomes and lessen disparities in cancer care, ACS actively advocates for

government policies that guarantee more people have insurance coverage for cancer screenings,

treatments, and follow-up care. These policies, especially those that increase access to

healthcare, like the ACA, has a significant impact on the ACS's ability to coordinate cancer care.

Early diagnosis by assisting individuals in getting screened for cancer sooner, more

age-appropriate therapy, reasonably priced health insurance, coverage for colorectal cancer

screening, and advancements in cancer care are some examples of how the ACA has affected the

ACS. Two significant pieces of legislation that safeguard people and their medical records are
 3

the ACA and the Health Insurance Portability and Accountability Act (HIPAA): HIPAA offers

patient protections and protects patient health information (PHI). ACA strengthens and expands

upon the privacy protections provided by HIPAA. ACA stipulates that pre-existing conditions

cannot be excluded from coverage or result in higher premiums, and that group health plans are

prohibited from charging different premiums or payments depending on health criteria.

Policy Provisions

Potential ethical conundrums when coordinating cancer care through the ACS can be

brought on by state laws governing insurance coverage for particular treatments, national

policies regarding patient data privacy (HIPAA), and regional differences in access to clinical

trials. These factors can lead to disparities in the way care is delivered and raise issues of equity

and patient autonomy based on geographic location. According to Yabroff et al. (2020), state

policies that promote continuity of health insurance coverage may reduce inequalities. Medicaid

eligibility in certain states, the ACA's increased availability of health insurance coverage options,

the expansion of dependent coverage on parents' private plans for young adults up to age 26, and

the availability of subsidies to reduce premium costs could all help to reduce interruptions and

encourage ongoing health insurance coverage.

According to Edemekong et al. (2024), patient control over medical records and

protection of personal health information are two benefits of the HIPAA national policy. There

may be both civil and criminal sanctions for breaking HIPAA. Almost each medical professional

has the ability to violate HIPAA, making it a dangerous place to work. In the regular course of

work, employees with lower levels of education and comprehension can readily break these

norms. Most criminal infractions are temporary slips that lead to expensive errors. Creating and

maintaining systems that reduce human error is essential, as is HIPAA education and training.
 4

Disparities in clinical trial access between states can have serious ramifications and

effects, mainly resulting in healthcare access disparities for specific populations, possibly

impeding the creation of treatments that successfully meet the needs of various patient groups,

and aggravating pre-existing health inequities by restricting the applicability of research findings

to larger populations. Research by Bibbins-Domingo and Helman (2022) indicate that improved

representation in clinical trials could lead to even small reductions in health inequities, saving the

American people billions of dollars. Expanding this estimate to include more conditions such as

cancer, lowering the health discrepancy more thoroughly, or calculating over future cohorts

would only raise the potential benefits of improved representation.

Impact of the Code of Ethics

By encouraging open communication, teamwork among healthcare professionals,

patient-centered decision making, and a strong emphasis on advocating for patients' needs across

various healthcare settings, the Code of Ethics for Nurses has a significant impact on care

coordination and continuum, ultimately guaranteeing seamless transitions and consistently

high-quality care throughout the patient journey. According to Haddad and Geiger (2023), all

healthcare workers must sustain ethical principles. Ethical practice acts as a foundation since

nurses deal with ethical dilemmas on a daily basis. When nurses provide patient care, moral

dilemmas come up. These moral issues can occasionally clash with the Code of Ethics or the

personal ethical principles of the nurse. When delivering care, nurses must find a balance in their

role as patient advocates.

For the ACS, a variety of factors influence health, health disparities, and access to

services. These include socioeconomic factors like health insurance status, environmental

disadvantages, cultural factors, migration history, social structures and practices like poverty,
 5

implicit bias, and discriminatory behavior. Social determinants of health encompass a wide range

of systems and influences that influence day-to-day living. These include development

objectives, political systems, economic systems and policies, social norms, and social policies.

Healthy People (2020) identifies social determinants of health as aspects of the environments in

which individuals are born, live, learn, work, play, worship, and age that affect a range of health,

functional, and quality-of-life outcomes and hazards. According to Healthy People (2020),

important social determinants of health include social and community context, neighborhood and

physical environment, health and healthcare access, education, and financial stability. Certain

factors, such as employment, income, food security, access to high-quality education, housing

quality, community safety, and transportation, have a major impact on overall health outcomes.

Conclusion

In conclusion, the ACS, a community organization which was interested in learning about

ethical and policy concerns pertaining to care coordination, was discussed. This assessment

outlined the ways in which community safety and/or specific health-related government

regulations impacted care coordination. Discussed instances of particular laws, like HIPAA, that

have an impact on the ACS. National, state, and local policy measures that presented ethical

issues for care coordination were discovered by this review. Also mentioned the effects and

ramifications of particular policy clauses. This assessment evaluated how the nursing code of

ethics affected care coordination and continuity. Also discussed the variables that affect health,

access to services, and health inequities. This assessment utilized Healthy People (2020) list of

social determinants of health as a guide while doing this evaluation.

By focusing its work on four key pillars—advocacy, discovery, patient support, and

development—the ACS is enhancing the lives of cancer patients and their families. In essence,
 6

ethical and policy factors serve as a framework to ensure patients receive the best care while

upholding their autonomy and dignity. They do this by ensuring patient-centered decision

making, protecting patient rights, promoting quality care, and assisting healthcare providers in

navigating complex situations when coordinating care across various healthcare settings while

abiding by legal and moral standards. By offering a clear framework for decision-making,

preventing misconduct, promoting transparency, and ensuring that public officials act in the best

interests of the people rather than their own personal gain, government policies, policy

provisions, and an ACS code of ethics are essential for ensuring ethical governance.
 7

References

Bibbins-Domingo, K., & Helman, A. (2022, May 17). Why diverse representation in clinical

matters and the current state of representation within the clinical research ecosystem.

Improving Representation in Clinical Trials and Research - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK584396/

Code of Ethics for Nurses. (2017, October 26). ANA.

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-fo

r-nurses/

Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2024, February 12). Health Insurance

Portability and Accountability Act. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK500019/

Haddad, L. M., & Geiger, R. A. (2023, August 14). Nursing Ethical Considerations. StatPearls -

NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK526054/#article-92.s3

Healthy People. (2020). Healthy People 2020 midcourse review. In Social Determinants of

Health. Centers for disease control and prevention, health resources and services

administration, office of disease prevention and health promotion, office of the assistant

secretary for health, office of the secretary.

https://www.cdc.gov/nchs/data/hpdata2020/hp2020mcr-c39-sdoh.pdf

Yabroff, K. R., Reeder-Hayes, K., Zhao, J., Halpern, M. T., Lopez, A. M., Bernal-Mizrachi, L.,

Collier, A. B., Neuner, J., Phillips, J., Blackstock, W., & Patel, M. (2020). Health

insurance coverage disruptions and cancer care and outcomes: Systematic review of

published research. Journal of the National Cancer Institute, 112(7), 671–687.

https://doi.org/10.1093/jnci/djaa048