als and receive reimbursement on a fee-for-service basis; or b) receive a monthly allotment for case managed services plus an additional fee-for-service for any direct care they provide.
In short, managed care systems tend to be large companies or organizations supplying diverse medical services to relatively large collectives of people on a for-profit basis. In this regard, Poplin (1995) has noted that the for-profit orientation of managed care systems places a heavy emphasis upon such factors as efficiency, and the provision of those services that foster profit as opposed to those services associated with loss. The result of this orientation, according to Poplin, is at best, an impersonal system of care and, at worst, low or inadequate quality of care.
Most nurses aim at quality care within the confines of the system for which they work. To upgrade the quality of low/inadequate medical care requires more than merely changing the roles or job tasks of nurses. However, regarding impersonal health care delivery, this is an area in which nursing can function in a strongly remediative role.
It is the impersonality of the managed care system that can, to a large measure, be redressed by the Transcultural Nurse Specialist. The next section of this review defines this specialty and explores its function in relation to helping managed care become less impersonal.
Transcultural Nursing: Its Function in Managed Care
The Journal of the American Medical Association (November 19, 1995) has stated that personalizing medical care means having health care personnel who are sensitive and responsive to a given client's medical needs as well as his perceived and personal needs. However, clients' perceptions of their needs in a situation requiring medical services can and does differ as a function of differences in patient culture or ethnicity.
For example, while white or Euro-Americans favor having their doctor provide t...