The health care delivery system of today has undergone tremendous change, even over the relatively short period of the past decade. New and emerging technologies, including drugs, devices, procedures, tests, and imaging machinery, have changed patterns of care and sites where care is provided. The growth of managed care and payment mechanisms employed by insurers and other payers to control the rate of health care spending has also had a major impact on health care utilization. People who cannot pay for health services, either out-of-pocket, through private or social health insurance such as Medicare, through public program such as Medicaid may not receive needed health care in the United States.

Health reform worldwide is required due to the largely aging population, increase in chronic disease, and rising costs (ANA, 2012). To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in the health policy, planning, and provision. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost-effective way.

Improving the health care delivery system is a key to improving the health of all Americans. Even if the access, quality, and cost problems in the medical system are resolved, a traditional view of the delivery system must expand to include population- wide program for the system to reach its full potential.

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