Healthcare Delivery Changes for Nursing Practice

Recent healthcare reforms have focused on disease prevention, population health, access, cost control, and quality. These changes have significant implications for nursing practice and roles. This essay examines how changes in the healthcare delivery system could transform nursing practice, compares and contrasts the US model to that of another country, and describes how an alternative approach would benefit vulnerable populations and alter nursing roles.

Changes in Healthcare Delivery System

Healthcare transformation efforts seek to achieve integrated and coordinated care, reduce barriers to access, minimize costs, improve quality, and alleviate disparities. To realize these goals, nurses at all levels and settings would be required to lead these change initiatives, acquire new skills, and collaborate with other professionals to achieve patient-centered care (Salmond & Echevarria, 2017). The changes would also demand that wellness and preventive care are prioritized in care delivery. For example, nurse-led health education that addresses disease risk factors is seen as a solution to the cost and disparity problems (Salmond & Echevarria, 2017). A patient/family-centric focus is also required in the transformed system to provide holistic care. Employing motivational interviewing to help patients achieve behavioral modification is an excellent example of a patient-centered approach to care. Nurses can also coordinate care to ensure effective transition by working with other professionals, including physicians (Kirsch, 2018). They can use outcome data to achieve enhanced inpatient experience and care efficiency by recommending intensive interventions like case management for high-risk patients.

Comparison and Contrast of Healthcare Delivery Systems

The US health care delivery system is highly elaborate with an array of providers, facility networks, and insurers. According to the Department for Professional Employees [DPE] (2016), this hybrid model involves “a single-payer or a multi-layer universal insurance” scheme but lacks universal coverage (p. 1). Specific differences can be noted between the US health care system and that of the Netherlands. The Dutch per capita expenditure on the health sector is lower than that of the US ($5,202 vs. $8,713) (World Health Organization, 2018). Costly medical technologies and drugs, a high burden of chronic illnesses, and significant administrative costs account for the difference in spending between the two countries.

Despite the high expenditure on healthcare, treatment inequalities are higher in the US than in the Netherlands. The American system is characterized by disparities in coverage, specialized care, and inadequate primary care, resulting in poorer health outcomes than that of other OECD countries like the Netherlands (DPE, 2016). The US system comes in last on efficiency and equity while the Dutch model is ranked fifth (DPE, 2016). Thus, health reforms are required in America to improve on these indicators.

Another Type of Healthcare System

People predisposed to health disparities require health promotion at the individual, family, and community levels. A healthcare system that focuses on primary care and prevention rather than on specialized services would result in better health outcomes for the vulnerable populations. The American Nurses Association (2018) advocates for primary health care centered on nurse-patient relationships, preventive, and coordinated rehabilitative services. Specifically, this approach to care would address the high prevalence of chronic illnesses, such as obesity and diabetes, in racial/ethnic minorities like Hispanics. The focus would be on the prevention and control of factors that increase the risk of disease in these populations. The nursing role would change in a primary care system. Nurses would serve as care coordinators and health educators of the target communities to reduce hospitalizations and related costs and improve outcomes. For example, when providing wound care for diabetic foot disease, a nurse can teach the patient diabetes self-management skills. Additionally, follow-ups in pediatric care could entail checking whether a child’s vaccine report is up-to-date.


Reforms in the US health care system require nurses to become care coordinators and health educators. The changes seek to reduce costs and improve quality through primary care and prevention. Improved collaboration and integration can help achieve these goals.


American Nurses Association. (2018). Health system reform. Web.

Department of Professional Employees [DPE]. (2016). The U.S. health care system: An international perspective. Washington, DC: DPE Research Department.

Kirsch, D. E. (2018). Health policy and the delivery system. In C. L. Edelman & E. C. Kudzma (Eds.), Health promotion throughout the life span (pp. 47-83). St. Louis, MO: Elsevier.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopaedic Nursing, 36(1), 12-25. Web.

World Health Organization. (2018). Countries: Netherlands. Web.