Healthcare reform: past and future.

PURPOSE

To review changes in the healthcare delivery system and project the challenges that practitioners and consumers will face in a reformed environment.

DATA SOURCES

Professional journals and books, print media, and government releases.

DATA SYNTHESIS

Analysis of projected reform plans, discussions of issues related to complex social, economic, and political factors, and considerations for practice changes for oncology nurses.

CONCLUSIONS

The pending dominance of healthcare delivery through managed-care systems will challenge oncology care providers and consumers.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses must identify the opportunities, master the challenges, and adapt to the trends of the reformed healthcare system. The delivery of long-term care to senior citizens, patients with AIDS, and individuals from diverse cultures will shift to more community, ambulatory, and rural managed-care settings. Oncology nursing practice in these environments raises questions about prevention and screening, diagnosis, treatment, follow-up, alternative care, and research. Oncology nurses, especially advanced practice nurses, will play a pivotal role in reshaping the delivery of patient care and in designing the future of their profession.