Many healthcare administrator believe in the concept of healthcare promotion services which to increase the effectiveness of recovery and reduce the number of repeat episode of illness. Nurse have long been recognized for their expertise in patient education , counseling and case management skills.
The national health agenda addresses several problem in the national healthcare such as ensuring that all American have access to care, and not just emergency care but prevention services and care for chronic conditions, bringing cost under control, and maintaining or improving quality of care.
In 2010, Unites States spent 17% of the national economy on healthcare compared to 9.5% on average across the 34 member countries of the International organization for economic development. U Healthcare can be reduced by increase in utilization of Nurse practitioner(NP). NP services cost 40% less than Physician services and are cost effective in preventive services. Research has showed that NP can manage 80-90% of what physician do without the need for consultation. The department of human services reports a comparebvle office visit can range from 10%-40% less in favor of NP without compromising patient satisfaction and quality of care. Recent literature has found that employing NP fully could save the 20% cost of primary care . It is estimated that US may be spending 8.7 billion that could be saved by utilizing NP. Tbe US healthcare is challenged by shifting demographics , economic and political pressure. The growth of chronically ill and the elderly population will create gap in the healthcare quality and increase in healthcare spending will intensify the demand for high quality primasry care at the same time . the supply of primary care physician is expected to shrink. Integrating the contribution of and the skills of all provider and specifically , the contribution of NPs is a vital policy step in achieving high value healthcare.
Strengthening the healthcare overall is essential to healthcare of all nations and promoting access to healthcare and as well as controlling cost in a quality cost effective way. NPs have demonstrated to be efficient and cost effective provider in n numerous research, however many states restrict their practice.
It was noted that states with fill practice nurse practitioner have lower hjospitalzation rate and improved healthcare outcomes in their communities. systematic review covering literature in four APN role noted that patient outcome for APNs were equal to or in some cases better than outcome for care provided by physisician alone.

Reference
Oliver,G, Pennington,L, Rantz M(2015). Impact of Nurse practitioner on healthcare outcomes of Medicare and Medicaid Patient. Nursing Outlook 1-8