Now What? Neighborhood Nursing's Answer to the US Health Care Paradox of Spending More but Getting Less

Policy Points Scalability and policy pathway: The universal access to health and social care provided by Neighborhood Nursing can be sustained by states leveraging existing policy frameworks like States Advancing All-Payer Health Equity Approaches and Development (AHEAD). Trust in health systems: With the United States at a low point for trust in expertise, Neighborhood Nursing can improve community trust in medical expertise using longitudinal relationships with trusted nurses and community health workers. Transformative impact: Neighborhood Nursing offers a framework that integrates multiple governmental levels for expanding health care policy from treatment-focused in health facilities to prevention-focused in people's homes and communities.

Despite spending more per capita on healthcare than any other nation, the United States experiences declining life expectancy and increasing chronic disease burden-a paradox reflecting fundamental limitations in the current treatment-centered, facility-based care system. This paper introduces Neighborhood Nursing, an innovative universal care infrastructure designed to shift the US healthcare toward proactive, prevention-centered care organized geographically in neighborhoods.

Neighborhood Nursing connects every person within defined geographic areas to interdisciplinary teams of nurses and community health workers who provide promotive, preventive, and restorative services in homes and community hubs. The infrastructure operates in an institutional architecture that integrates activities across three levels: neighborhood services, state-level operational platforms, and a national center supporting research and thought leadership, operational excellence and growth, systems design and evolution, and policy orchestration and advocacy.

Drawing on international evidence-based models like Costa Rica's EBAIS and other community-oriented primary care approaches, Neighborhood Nursing addresses three core challenges in US healthcare: the prioritization of provider expertise over lived experiences, the system's reactive nature focused on treating illness rather than promoting health, and inequitable access that perpetuates mistrust in health systems, especially in marginalized communities.

This paper introduces Neighborhood Nursing, contrasts it with the current US system, examines international precedents, discusses implementation within value-based payment ecosystems, and outlines evaluation approaches for assessing health outcomes, community trust, and system efficiency.