Chapter 2: The Health Care Delivery System

The Health Care Delivery System establishes the framework of the six distinct levels of care—preventive, primary, secondary, tertiary, restorative, and continuing health care—and clarifies how these differ from levels of prevention. The discussion explores the financial and regulatory structures that influence practice, including the Affordable Care Act, Medicare, Medicaid, and the shift toward value-based reimbursement models like the Inpatient Prospective Payment System (IPPS) and Diagnosis-Related Groups (DRGs). A significant focus is placed on the importance of Integrated Health Care Delivery (IHCD) systems and Accountable Care Organizations (ACOs) in coordinating services to improve population health. The summary details the nurse's responsibilities across various settings, from acute care hospitals and intensive care units (ICUs) to the essential process of discharge planning, which is identified as a multidisciplinary effort that must begin at admission to prevent readmissions and ensure safe transitions. It further outlines restorative care options, such as home health care and rehabilitation, and continuing care environments, including nursing centers, assisted living, adult day care, and respite care. The text highlights specific assessment tools like the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) used in long-term care. Additionally, the chapter distinguishes between palliative care and hospice care for life-limiting illnesses. Finally, it addresses contemporary challenges and trends facing the profession, such as the nursing shortage, the impact of competency frameworks like QSEN and Magnet Recognition, the integration of robotics and telehealth, and the profound effects of social determinants of health on health care disparities and access.