A review of the literature: differences in outcomes for uninsured versus insured critically ill patients: opportunities and challenges for critical care nurses as the Patient Protection and Affordable Care Act begins open enrollment for all Americans.

The US health care system stands alone in its uniqueness compared with other industrialized nations. Unlike other developed nations, the United States does not provide universal health care coverage to its citizens. America relies primarily on private health insurance, allowing for protection against the high cost of illness. Because of the economic recession, many Americans cannot afford to pay for private health insurance. Contemporary nursing research is reviewing the question "Is there is a difference in patient outcomes for the critically ill depending upon whether or not they have private health insurance?" By using the Johns Hopkins Nursing Evidence-Based Practice Model (Johns Hopkins Nursing Evidenced-Based Practice Model and Guidelines. 2nd ed. Indianapolis, IN: Sigma Theta Tau International; 2012), 6 articles (level III and IV) were reviewed and summarized. After reviewing all the evidence, it is apparent that there are poorer patient outcomes, more specifically death in the critically ill patient population, if the patient does not have private health insurance. Current recommendations from these studies support the Patient Protection and Affordable Care Act (http://www.ehealthinsurance.com), which will take effect in 2014 and will enable uninsured individuals to have access to medical insurance. This provision can also improve preventative care and overall patient outcomes. This article has implications for the critical care nurse in the following ways: First, it will help the nurse to interpret the implications of the Patient Protection and Affordable Care Act and how it will impact critical care practice; second, it validates the challenges that uninsured patients present to acute health care facilities as they come with more complications and consequently are at greater risk for complications; third, it magnifies that the critical care nurse may see millions of new patients; and fourth, it demonstrates for the critical care nurse how to use the Johns Hopkins Nursing Evidence-Based Practice Model to answer questions.