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Health care disparities exist in the United States. Social inequalities contributing to disparities in health care include poverty, socioeconomic status, being uninsured, one's life course, and being unemployed. Each social inequality has an effect on health status and produces a gradient of poor health and mortality that spans all socioeconomic strata. Selected policies implemented in the United States have resulted in perpetuating health care disparities and negative health outcomes for certain populations. Health care professionals are in a strategic position to implement pragmatic strategies for eliminating some health disparities. Strategies discussed include changes at the following levels: personal, worksite, professional association, community, and civic.

Changes in the health care system are threatening the independence and professionalism of health care providers. One such proposed policy change related to professional licensure is creating a specific challenge for the nursing profession. This article examines how the licensure challenge affects aspects of autonomy, independence, and integrity of the nursing profession with special emphasis on one group of nurses—that of nurse practitioners. The impact of the PEW Commission's study is analyzed as well as the concern for potential loss of individual licensure for nurses. Nursing groups have responded to the PEW Commission study to prevent such deregulation of the nursing profession.

“Managed care is the health law issue of 1999” (Leibold, 1999, p. 5). This chapter addresses changes in the health care system initiated by the managed care paradigm — which, in turn, has prompted many legal changes and challenges. Specifically, this chapter will describe the following: (a) an overview of the managed care system versus the traditional fee-for-service system; (b) a selected review of research literature on the strengths and limitations of the managed care system; and (c) a projection of the future trends of the managed care system for patients, consumers, health providers and society. The second area, the review of research literature, will include the impact of managed care on patients, consumers, physicians and nurses. In this chapter, the word patient, means someone who is ill; the word consumer, means someone who has health insurance and may become ill in the future and needs to utilize the health delivery system.