Gould E J
J N Y State Nurses Assoc. 1989 Mar;20(1):4-7.
Concern for quality, cost, and access dominate the health care system in the eighties. State and national actions, demographic changes, and technological advances are converging to create many changes in the home care delivery system. Knowledgeable nurses can influence the evolution of home care services to assure that patients receive appropriate acute and long term home care services. Concern for quality care, changing patient needs, and availability of care are the major issues facing home care nursing in the eighties, and will continue to be into the nineties. Reimbursement policies of third party payers, medicare/medicaid regulations, state licensing, employer benefit programs, state health programs, home health care providers, professional/trade associations, and consumer advocacy groups are some of the key forces reshaping the practice of home health nurses. Knowledge of these factors will enable nurses to influence effectively the design of institutional and governmental policies which affect the care nurses deliver to patients at home.
对质量、成本和可及性的关注主导了八十年代的医疗保健系统。州和国家层面的行动、人口结构变化以及技术进步正共同作用，给家庭护理服务体系带来诸多变革。知识渊博的护士能够影响家庭护理服务的发展，以确保患者获得恰当的急性和长期家庭护理服务。对优质护理的关注、不断变化的患者需求以及护理的可获得性是八十年代家庭护理面临的主要问题，并且在九十年代仍将如此。第三方支付方的报销政策、医疗保险/医疗补助法规、州执照规定、雇主福利项目、州健康项目、家庭医疗保健提供者、专业/行业协会以及消费者权益倡导组织，都是重塑家庭健康护士执业方式的一些关键力量。了解这些因素将使护士能够有效地影响机构和政府政策的制定，这些政策会影响护士在家为患者提供的护理。
