Health Care Policy and Economics

Course Description

NUR4837C – Health Care Policy and Economics is a 3-credit upper-division nursing course examining how health policy, financing, and system structure determine who gets care, what it costs, and how good it is. It is a required course in Florida RN-to-BSN and prelicensure BSN curricula.

The course exists because clinical competence is not sufficient. A nurse who does not understand why a patient was discharged early, why a medication is unaffordable, why a rural hospital closed, or why staffing is what it is cannot advocate effectively for patients or for the profession. The course supplies that context.

Content covers the structure of the U.S. health care system and how it compares internationally; financing — Medicare, Medicaid, commercial insurance, the uninsured, and out-of-pocket burden; payment models including fee-for-service, prospective payment, DRGs, capitation, and the shift toward value-based care; and the basic economics a nurse needs: supply and demand in health markets, why health care departs from ordinary market assumptions, cost-benefit and cost-effectiveness reasoning, and the persistent tension among cost, quality, and access.

Policy process is treated practically: how legislation and regulation actually happen, who influences them, and how a nurse or professional organization participates. The Affordable Care Act and subsequent developments provide the working case study.

Nursing-specific policy receives substantial attention — scope of practice regulation, staffing ratios and their relationship to outcomes, workforce supply and the nursing shortage, reimbursement for nursing services, and the profession's advocacy role.

Florida context is distinctive and worth naming: Florida has not expanded Medicaid under the ACA, leaving a coverage gap; the state has one of the highest uninsured rates nationally; and its very large Medicare population, substantial rural hospital pressures, and hurricane-driven emergency preparedness requirements make it a genuinely different policy environment from most states.

Offered at approximately 17 Florida institutions with BSN programs.

Learning Outcomes

Required Outcomes

• Describe the structure of the U.S. health care delivery system and its principal components.
• Compare the U.S. system to other developed nations on cost, access, and outcomes.
• Describe health care financing including Medicare, Medicaid, commercial insurance, and self-pay.
• Explain payment models including fee-for-service, prospective payment, DRGs, capitation, and value-based purchasing.
• Apply basic economic concepts to health care markets and explain how they depart from standard assumptions.
• Analyze the relationships among cost, quality, and access.
• Describe cost-benefit and cost-effectiveness analysis and their use in policy decisions.
• Explain the policy-making process at state and federal levels and identify points of influence.
• Analyze the Affordable Care Act's provisions and effects.
• Describe Florida-specific policy including Medicaid expansion status and its consequences.
• Describe nursing scope of practice regulation and its policy basis.
• Analyze the evidence linking nurse staffing to patient outcomes.
• Describe nursing workforce supply, demand, and shortage dynamics.
• Describe the nurse's role in policy advocacy and professional organization participation.
• Analyze a current health policy issue and construct a supported position.

Optional Outcomes

• Analyze social determinants of health and their policy implications.
• Describe health disparities and equity-focused policy responses.
• Describe rural health policy and access challenges.
• Describe emergency preparedness policy and hospital obligations.
• Communicate with a legislator or participate in an advocacy activity.
• Describe global health policy and international nursing.

Major Topics

Required Topics

• The U.S. health care system — structure, providers, settings, and historical development.
• International comparison — spending, outcomes, and system design in peer nations.
• Financing — Medicare parts, Medicaid, CHIP, commercial insurance, and the uninsured.
• Payment models — fee-for-service, DRGs, capitation, bundled payment, and value-based purchasing.
• Health economics fundamentals — supply and demand, elasticity, moral hazard, and information asymmetry.
• Cost, quality, and access — the iron triangle and the tradeoffs it describes.
• Economic evaluation — cost-benefit, cost-effectiveness, and quality-adjusted life years.
• The policy process — legislation, regulation, agencies, and stakeholder influence.
• The Affordable Care Act — provisions, coverage effects, and subsequent modification.
• Florida health policy — Medicaid expansion status, the coverage gap, uninsured rates, and rural hospital pressure.
• Scope of practice — regulation, Florida's Nurse Practice Act, and APRN authority.
• Nurse staffing and outcomes — the evidence base and staffing policy debates.
• Nursing workforce — supply, demand, education pipeline, and shortage dynamics.
• Advocacy — the nurse's policy role, professional organizations, and effective participation.
• Quality and safety policy — never events, readmission penalties, and public reporting.

Optional Topics

• Social determinants of health.
• Health disparities and equity policy.
• Rural health access.
• Emergency preparedness and hospital obligations.
• Legislative advocacy activity.
• Global health policy.

Resources & Tools

• Policy and Politics in Nursing and Health Care (Mason, Dickson, Perez & McLemore), Elsevier — the standard text in the field.
• Health Policy and Politics: A Nurse's Guide (Milstead & Short), Jones & Bartlett — widely adopted.
• Introduction to Health Care Economics and Financial Management or comparable economics primers for nurses.
• KFF (Kaiser Family Foundation) — free, authoritative state-level data including Florida Medicaid and coverage statistics; the single most useful source for coursework.
• CMS — Medicare and Medicaid program information, payment rules, and quality reporting.
• Florida Agency for Health Care Administration (AHCA) — state program data and facility information.
• Florida Board of Nursing and Chapter 464, F.S. — scope of practice.
• American Nurses Association and the Florida Nurses Association — policy positions and advocacy resources.
• Online Sunshine — Florida legislative tracking for current bills.

Career Pathways

• Registered Nurse (SOC 29-1141) — policy literacy supports advocacy in any setting.
• Nurse Manager and Nurse Executive (SOC 11-9111) — budget, staffing, and reimbursement decisions require this content.
• Case Manager and Care Coordinator — navigating coverage and payment is the daily work.
• Quality and Patient Safety roles — where reimbursement and quality policy intersect.
• Public Health Nurse — county health departments and population health programs.
• Nurse Policy Analyst or Lobbyist — professional associations and government affairs.
• Graduate study — MSN and DNP programs in leadership, executive nursing, and health policy.

Special Information

Course-title and code variation

Titles differ considerably: Health Care Policy and Economics (the SCNS title), Healthcare Policy and Economics in Nursing (Seminole State), and Health Care Issues, Policy, and Economics (UCF). The course also appears as both NUR4837 and NUR4837C, the C form indicating an added applied or project component — often a policy analysis paper or an advocacy activity. Under SCNS these are equivalent at the same level.

Prerequisites

Admission to a BSN program is the universal requirement. In RN-to-BSN programs the course is typically placed later in the sequence, after NUR3805 Nursing Role and Scope and the research or evidence-based practice course, since it assumes both professional framing and the ability to evaluate evidence. Prelicensure programs place it variably. Verify locally.

Florida's policy environment is genuinely distinctive

Students should understand this rather than reading national material as if it described Florida. The state has not adopted Medicaid expansion, which leaves a coverage gap for adults earning too much for Medicaid and too little for marketplace subsidies; Florida has among the highest uninsured rates in the country; it has an unusually large Medicare population; and rural hospital financial pressure is acute in parts of the state. National textbooks written around expansion states describe a system Florida nurses do not work in. Instructors generally use Florida data deliberately for that reason.

Position in the curriculum and its relationship to graduate study

This course is commonly among the last in an RN-to-BSN sequence and frequently pairs with or precedes the capstone. It is also the undergraduate foundation for graduate health policy coursework in MSN and DNP programs, where policy analysis is a required competency.

The material is politically contested, and the course should handle that honestly

Health policy involves genuine disagreement about values, not only about facts. A well-taught version of this course distinguishes the two: what the evidence shows about a policy's effects is an empirical question; what tradeoffs are acceptable is not. Students are generally assessed on the quality of their reasoning and their use of evidence rather than on reaching a particular conclusion, and instructors typically make that standard explicit early.