as been found to be effective in the combined context of cost containment and improving care quality (Manion, 1991, pp. 18 21; Behner and Hagerott, 1991, pp. 30 34).
In the 1990s also, government has found that nurse practitioners and clinical nurse specialists can play a vital role in the delivery of health care services to the indigent. As costs associated with the delivery of health care services soared in the 1980s and continue to increase in the 1990s, third party funders, health care providers, and users of health care services sought and continue to develop and implement procedures and programs that will either stabilize costs or reduce the rate of increase of such costs. Health care services funded by government received special scrutiny. Indigent people are almost entirely dependent upon cost free or sliding scale fee health care services delivery. Thus, cost containment measures that affect the delivery of governmentally funded health care services tend to have a devastating impact on the accessibility of health care services to the homeless and to all indigent persons in American society. Indigent persons tend to postpone medical consultation and treatment to avoid incurring costs they cannot afford. As a consequence, when they do receive health care services, those services are typically more extensive and more costly than would have been the case, had consultation and treatment been sought earlier. The higher cost of these deferred services adds further pressures to the problem of funding health care services for the indigent, including the homeless. It is into this situation of health care services need for the na
...