Managed Care

Significant changes in the health-care delivery system during the past few years has resulted in shifts in managed care. Under this system, the fundamental assumptions of health-care delivery have been challenged and are beginning to change: emphasis on health, not illness, primary versus specialty care, hospital-based care to care networks, and revision of medical education patterns. The resulting opportunity for nursing has assisted in the expansion of its care to a practitioner model within the acute-care setting. Through case management and direct acute-care patient management, acute-care nurse practitioners (ACNPs) may ultimately contribute to reductions in hospitalization costs. Literature suggesting actual costs of ACNPs to be high must be measured against their invaluable contributions to increased quality of care. Detailed evaluation programs are needed for more complete analysis. An example of ACNP practice at a large teaching hospital shows varied interpretations of the role.