care services (Lee, 1993, p. 2784). A typical outcome for such people is that they finally seek emergency medical care when their health conditions have degenerated to the point where such conditions can no longer be ignored.
The important outcomes of the combination of delaying needed health care services and then obtaining those services through a hospital emergency department relate to patient health, health care costs, and the efficient functioning of the health care system. First, the health of individuals exhibiting such behaviors is compromised (Franks, Clancy, Gold, and Nutting, 1993, pp. 1295-1299). Second, the costs for the health care services provided are far higher than they otherwise would have been (Lee, 1993, p. 2784). Third, hospital emergency departments are overwhelmed with a consequent deterioration in the quality of care delivered (Rubin, Gendek, and Rogers, 1993, pp. 835-840). Any one of these outcomes supports the consideration of health care reform. The combined effects of these outcomes demands health care reform in the United States.
Schiff, Bindman, and Brennan (1994, pp. 803-808) contend that an inseparable relationship exists between access and quality in medicine. Certainly, this argument is valid, because in the absence of access quality in health care is a meaningless concept.
One approach to improving access to healthcare services in the United States is through an increased use of clinics managed by nurse practitioners. A nurse practitioner is defined as one who provides some level of health care directly to patients without direct supervision by a physician (Cushner, 1986, p. 216). Nurse practitioners are among the most prominent of the non physician health care pr
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