The present federally funded Canadian healthcare system has been driven principally by insured physicians and hospitals providing acute and episodic care that is a poor match to the changing demographics of persons with chronic disease living longer. The current health system consumes nearly one-half of provincial budgets.

Models of proactive, targeted nurse led care that focus on preventive patient self-management for people with chronic disease are either more effective and equally or less costly, or are equally effective and less costly than the usual model of care.

Additional key components of more effective and efficient healthcare models involve community based, nurse led models of care with an interdisciplinary team that includes the primary care physician. Such complex intervention requires specially trained or advanced practice nurses who supplement the care provided by physicians and other healthcare professionals. The proactive, comprehensive, coordinated model of community care is patient and family centered, targeted at community-dwelling individuals with complex chronic conditions and social circumstances.