nd toward the development of a two tiered system of health care services delivery in this country. Increases in the cost of health insurance is another factor in this trend. Restrictions on health care coverage for the economically disadvantaged by a parsimonious government is yet another factor. A serious implication of this situation is the potential denial of access to necessary health care services for a large segment of the population.
The development of a pronounced two tier health care delivery system cannot but undermine the confidence of those in the lower tier in all health care professionals including the nurse. Nurses functioning in the delivery of health care services in the lower tier of such a system will also likely find their autonomy to practice diminished.
The AIDS crisis provides one illustration of the access problem (Burgess, & Ragland, 1983). AIDS victims without health insurance are generally denied coverage. Those with health insurance often find their coverage curtailed. Due to the nature of the syndrome, however, AIDS victims do not simply require access to health care services they also require access to humane alternatives to traditional care. Humane care alternatives (to hospital care) for AIDS victims have been found to be (1) hospice care, (2) home health care, and (3) out patient care (Taravella, 1986). Happily, these alternative approaches to the delivery of health care services to AIDS victims have also been found to be more effective medically than hospital delivered health care services. Additionally, the alternative approaches to the delivery of health care services have been found to be significantly less costly than the delivery of the services through hospitals.
In most cases, a combination of out patient care, home health care, and hospice care is required during the diagnosis to death period for AIDS patients. It has been found that the total costs of care...