Changes to Restructure the U.S. Healthcare Delivery System-Nursing Paper Examples

Healthcare Delivery System

The significant rise in healthcare services demands caused by increased median age and high prevalence of chronic illness, not to mention the COVID-19 pandemic, calls for effective healthcare delivery models. The United States government should prioritize advancing the nursing practice as nursing services are widely required in different healthcare settings. Therefore, in collaboration with the health industry, Federal and State governments should institute health reforms and regulations toward affordable and quality care (Healthcare Delivery System).

Healthcare Delivery System
U.S. Healthcare Delivery System

Formulation of policies and regulations to govern healthcare operations and regulate change improve current and future nursing practice. This paper describes the Sustaining Excellence in Medicaid Act of 2019 and its impact on nursing practice. The paper will also describe the pay for performance and quality measures that affect patient outcomes while highlighting how they affect practice and nurses’ responsibilities. Lastly, the paper will discuss nursing leadership roles in promoting patient safety, research emerging nursing trends, and predict how nursing roles will grow in the next five years (Healthcare Delivery System).

Current Healthcare Law and its Impact on Nursing Practice

The Sustaining Excellence in Medicaid Act of 2019(H.R. 3253) is the most recent Federal health law instituted by the U.S. government. Sponsored by Michigan Representative Dingell, Debbie introduced the bill on June 23, 2019, and passed it by Congress on August 6, 2019. It restructured the Medicaid program by adding some extensions to the program. First, the bill increased the appropriation for FY2019 (Healthcare Delivery System).

Second, the bills extended the Family-to-Family Health Centers Program and temporarily extended Medicaid eligibility to protect against spousal impoverishment and poverty (Congress.Gov, 2023). Third, the bill temporarily extended the State fraud unit to examine and consider non-institutionalized patients. Lastly, it requires drug manufacturers always to include generic drug prices and refers to the drug manufacturers as wholesalers.

The Sustaining Excellence in Medicaid Act has an immense influence on nursing practice. First, the bill reduces healthcare disparities in nursing practice. Besides health disparities, the bill protects citizens from spousal impoverishment. Initially, Medicaid denied poor service medical eligibility. However, the new reform extends Medicaid services to impoverished spouses (Healthcare Delivery System).

Secondly, the reform now considers non-institutionalized patients that Medicaid initially rejected. In this case, nurses should identify and educate impoverished patients about the new reform and its impact on their access to care. Nurses should also advocate for non-institutionalized patients to ensure they access quality care. Thus, the reform eliminated healthcare disparity and promoted health equity (Healthcare Delivery System).

Quality Measure, Pay for Performance Impact on Patient Outcomes and Nursing

Quality measures quantify healthcare processes, patient perceptions, and organizational systems/ structures linked to quality care and improve patient outcomes (Darney et al., 2019). Structure quality measures offer patients a sense of the healthcare provider’s capacity to deliver quality care. For example, electronic medical health records, a high ratio of providers to patients, and a high number of certified board physicians are structural quality measures associated with improved patient outcomes (Healthcare Delivery System).

Process quality measures portray what healthcare providers are doing to improve health. Thus, health promotion and immunization promote healthier communities, improving health outcomes. Lastly, outcome quality measures reflect the influence of health services or interventions. For instance, a high rate of hospital-acquired infections implies a lack of care quality and reduced patient outcomes.

Consequently, Pay for Performance (P4P) attaches financial incentives or disincentives to healthcare providers’ performance. The value-based model uses a fee–for–service system to tie reimbursement to proven best services, patient satisfaction, and metric-driven outcomes to align payment with the quality and value of care (Weismann et al., 2020). In this case, the P4P is a financial motivation, prioritizing quality of care over the number of services delivered (Healthcare Delivery System).

As such, the health payers redirect funds to encourage the providers to offer best practices that improve patient outcomes. However, the reward-based P4P system encourages cream skimming and patient dumping, where healthcare providers avoid complex health conditions whose trajectories impair remunerations and statistics (Fainman & Kucukyazici, 2020 (Healthcare Delivery System)).

Quality measures have had an immense impact on nursing practice. Quality measurement is a vital process of implementing change in nursing. In this case, the measures allow the nurses to identify the changes driving them toward quality care. As such, quality measure drives nursing toward evidence-based practice by adopting best and proven practices. Nonetheless, nurses have the mandate to measure the quality of their care. As such, the nurses learn to use evidence-based practice to offer value-based care to the patient for performance (Healthcare Delivery System).

Nursing Leadership/Management Roles in Patient Safety and Quality Care

The health sector is changing rapidly. The significant changes call for new approaches and strategies for effective management and leadership in nursing. As a result, nurse leaders are mandated to be strategic, and proactive and engage in collaborative actions to ensure that the changing healthcare priorities are met. One of the emerging trends in nursing leadership is policy advocacy (Chiu, 2021). Through formal education, professional experiences, and real-time exposure to policymaking, nurse leaders are using their power to influence policymaking within the healthcare sector. In this case, the nurse leaders can delineate their value in patient care based on cost and patient outcomes, thus making it easy for them to engage in policy making (Healthcare Delivery System).

Nurse leaders also have a responsibility to promote quality care and patient satisfaction. Through influence in policymaking and decision processes, nurse leaders can adopt emerging nursing practice trends to improve the quality of care and patient practice. In addition, nurse leaders research and emphasize EBP within their teams to promote quality care. In this regard, nurse leaders oversee operations in nursing departments, assign duties, and motivate staff to provide quality care and meet patient needs (Healthcare Delivery System).

Emerging Trends in Nursing

Complex healthcare needs, aging populations, nursing shortages, and technological advancement have led to the evolution of the nursing profession. First, technological advancement has led to a significant rise in the use of telemedicine. Telehealth allows healthcare delivery and information via electronic information (Galiero et al., 2020). Telehealth promotes long-distance provider-patient contact to offer care, advice, education, intervention, and health monitoring. For instance, telehealth has been widely used during the COVID-19 pandemic (Healthcare Delivery System).

Second, the increased use of Electronic Medical Health Records (EMRs) has improved the quality of care through proper patient data management, thus preventing medical errors (Cerchione et al., 2022). Third, the nursing shortage has also triggered the need to improve nursing education. Providing education incentives such as scholarships, increasing university training, and nursing students’ admission is an emerging trend to remedy the nursing shortage (Healthcare Delivery System).

Transformation of Nursing Roles in the Next Five Years

Nursing roles are expected to transform in the next five years. Comprehensive nursing education and clinical experience have contributed to immense professional development and extended nurses’ responsibilities (Lundin Gurné et al., 2021). The growing demand for healthcare services calls for nursing educators and trainers to offer education, allowing nurses to handle medical emergencies without asking physicians in the next five years (Healthcare Delivery System).

The nurses will not be taking up the roles of doctors but will act as professionals with medical knowledge to support their clinical decisions. In the next five years, advanced nursing knowledge will allow nurses to venture into different medical disciplines, such as pediatrics, obstetrics, and gerontology. As a result, more nurses are expected to start more nurse-led clinics in the next five years. However, the government should implement regulations and guidelines to govern the opening and running of these nurse clinics.


Federal and State governments, in collaboration with the health industry, should institute health reforms and regulations to govern healthcare operations and regulate change to improve current and future nursing practice. The Sustaining Excellence in Medicaid Act of 2019 (H.R. 3253) is an example of a Federal health law instituted by the U.S. government to improve healthcare delivery. The act affects nursing practice by promoting healthcare equity and eliminating health disparities (Healthcare Delivery System).

Quality measures the quality of healthcare delivery, while P4P motivates health providers to offer best practices for improving patient outcomes. Subsequently, nursing leadership is instrumental in managing healthcare changes to improve health outcomes, patient satisfaction, and the adoption of current nursing trends. Thus, nurse leaders should adopt emerging trends such as new technology and promote the advancement of nursing education as strategies to improve the quality of care and patient outcomes.


Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2022). Blockchain’s coming to the hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem. Technovation, 102480.

Chiu, P. (2021). Advancing nursing policy advocacy knowledge: a theoretical exploration. Advances in Nursing Science44(1), 3-15.

Congress.Gov (2023). H.R.3253- Sustaining Excellence in Medicaid Act of 2019. Retrieved from

Darney, B. G., Kapp, N., Andersen, K., Baum, S. E., Blanchard, K., Gerdts, C., … & Powell, B. (2019). Definitions, measurement, and indicator selection for quality of care in abortion. Contraception100(5), 354-359.

Fainman, E. Z., & Kucukyazici, B. (2020). Design of financial incentives and payment schemes in healthcare systems: A review. Socio-Economic Planning Sciences72, 100901.

Galiero, R., Pafundi, P. C., Nevola, R., Rinaldi, L., Acierno, C., Caturano, A., … & Sasso, F. C. (2020). The importance of telemedicine during COVID-19 pandemic: a focus on diabetic retinopathy. Journal of diabetes research2020.

Lundin Gurné, F., Lidén, E., Jakobsson Ung, E., Kirkevold, M., Öhlén, J., & Jakobsson, S. (2021). Striving to be in close proximity to the patient: An interpretive descriptive study of nursing practice from the perspectives of clinically experienced registered nurses. Nursing Inquiry28(2), e12387.

Weismann, M., Ganske, S., & Delgado, O. (2020). Cleveland Clinic Florida “pay-for-performance” reimbursement: why the best care does not always make the happiest patients. The CASE Journal.

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