title: Healthcare reform: past and future.
abstract: OBJECTIVE
  To review changes in the healthcare delivery system and project the challenges that practitioners and consumers will face in a reformed environment.
  
  
  METHODS
  Professional journals and books, print media, and government releases.
  
  
  RESULTS
  Analysis of projected reform plans, discussions of issues related to complex social, economic, and political factors, and considerations for practice changes for oncology nurses.
  
  
  CONCLUSIONS
  The pending dominance of healthcare delivery through managed-care systems will challenge oncology care providers and consumers.
  
  
  CONCLUSIONS
  Oncology nurses must identify the opportunities, master the challenges, and adapt to the trends of the reformed healthcare system. The delivery of long-term care to senior citizens, patients with AIDS, and individuals from diverse cultures will shift to more community, ambulatory, and rural managed-care settings. Oncology nursing practice in these environments raises questions about prevention and screening, diagnosis, treatment, follow-up, alternative care, and research. Oncology nurses, especially advanced practice nurses, will play a pivotal role in reshaping the delivery of patient care and in designing the future of their profession.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: K C
authors.initials: KC
authors.lastname: McDermott
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D005544:Forecasting; D018166:Health Care Reform / Q000639:trends*; D006285:Health Planning / Q000458:organization & administration*; D006801:Humans; D008119:Lobbying; D008329:Managed Care Programs / Q000458:organization & administration; D017146:Models, Organizational; D009859:Oncology Nursing / Q000458:organization & administration; D009936:Organizational Innovation; D009937:Organizational Objectives; D011057:Politics; D012959:Socioeconomic Factors; D014481:United States