IMPROVING ACCESS TO HEALTHCARE THROUGH THE USE OF
NURSE PRACTITIONER MIDWIVES: A RESEARCH PROPOSAL
Dynamic change characterizes the American health care environment in the 1990s (Hammonds, 1994, pp. 48-57). A major problem associated with the dynamic character of this health care environment is the increase in the number of people whose access to health care services is beling limited. Limitations in access are related to the increasing costs of health care services, changing societal values in the United States that tend to reject the concept of universal access, advances in treatment therapies and technological innovation that freighten some people away from seeking care, changing demographics that create ever larger population groups with limited English language proficiency and limited education, and many other factors (Nichols and Stevens, 1992, pp. 86-95). Cost is a major factor involved in changes in the accessibility of health care delivery and support services. It is, therefore, imperative for health care delivery and support organizations to develop procedures that will lead to more effective and more efficient operations. Proposed national health care reform, increased consumer demands for quality health care, and public outcries for the control of health care costs are issues that must be addressed by all health care institutions in both the public and private sectors; however, such concerns should not be permitted to disassociate large segments of the population from the health care system.
In the United States in the mid-1990s, health care insurance is unattainable for some people and unaffordable for millions of others (Weil, 1994, pp. 5-15). The same factors that cause health care insurance to be either unattainable or unaffordable also result in delays by the people affected in seeking necessary health care services (Lee, 1993, p. 2784). A typical outcome for such people is that they finally seek eme...