Primary versus managed care?

In my experience, the difference is not in nursing but in how hospitals are paid. My hospital gets paid by insurance companies that are chosen by the patient or their employer. We also get paid by the Federal govt (Medicare and Medicaid) and cash (less frequent of course!). The services the nurse provides are the same for everyone. In fact, most nurses have no idea how the bill will be paid. It is not an issue to us. Insurance companies that represent workers may allow the patient to chose their own doctor and other healthcare providers, or in the case of managed care, will make the patient chose services from a list of providers. There are all sorts of variances. But the real point is, nursing is not involved in those choices and provides the same service to everyone.