The health reform battles of the past year revealed intense differences within political institutions and between key stakeholders. Ironically, disagreement over specific solutions often obscured general agreement on the problem—health care spending has finally become an unacceptable threat to the nation’s economic future. Allowing the substitution of NPs for more expensive health professionals can reduce the costs of producing health care without diminishing quality in the process.
Key Reform Issues: Cost-Effectiveness and Evidence-Based Quality
A fundamental principle of economic science, identifying the least-expensive way to produce a specified outcome, is a necessary foundation for this health reform to be meaningful and successful. Cost-effectiveness analysis clearly supports reversing rules and regulations that deny reimbursement to nurse practitioners while paying more-expensive health professionals for clinical services that achieve comparable results. Quality of care for Americans need not be reduced in the process. Decades of experience and dozens of published studies show that quality is not a problem with reforms that would allow nurse practitioners to provide more services. Nurse practitioners care for patients at least as well as physicians in many clearly defined areas of nursing and medical practice. A recent survey reveals when it comes to access and responsiveness, consumers frequently choose nurse practitioners over physicians. Consumers feel nurse practitioners are easier to see than physicians and that they are more likely to listen to patients and address their concerns. Removing inappropriate barriers to the use of nurse practitioners offers an excellent way to reduce the costs of care, without compromising quality, in treatment of simple to complex medical problems for patients of all ages.
The published literature unequivocally supports the proposition that quality of care will be maintained—and possibly enhanced—if health care reform promotes the use of nurse practitioners in their areas of demonstrated clinical expertise. In addition, all research studies that address consumer satisfaction suggest that patients like the care they receive from nurse practitioners at least as much as the care they receive from physicians.
Consumers’ overall appreciation of nurse practitioners is extremely high. The use of nurse practitioners can also save money in accord with another important goal of health reform, reducing the direct and indirect costs of professional liability (i.e., malpractice).
The Bottom Line: Nurse Practitioners Reduce Overall Health Spending
The published literature also shows that collaborative, team-based approaches to care—including teams led by nurse practitioners—should be actively promoted to reduce overall spending on health care. The recognition of a serious and growing undersupply of primary care physicians adds even more power to the case for expanding use of nurse practitioners. The United States simply does not have enough primary care physicians to coordinate patient care. Fortunately, NPs are available to fill many gaps in primary care at lower cost with impressive outcomes (quality). The full integration of nurse practitioners into daily practice as substitutes for other qualified health professionals in many clinical areas will also enhance access.
In conclusion, all the evidence supports using nurse practitioners as one of the most cost-effective and feasible reforms to solve America’s serious problems of cost, quality, and access to health care. Americans are paying an unnecessarily high price for a system that denies direct access to the cost-effective provider of many basic health services.
Jeffrey C. Bauer, PhD, is an internationally recognized medical economist and health futurist. He has published over 200 articles and books on the health industry, including numerous economic analyses of input substitution as a key to reducing costs and improving quality in medical care delivery. With a career that includes 17 years as a professor of statistics and research at two medical schools and service as health policy adviser to a state governor, he is now Chicago-based Vice President for Healthcare Forecasting and Strategy for Affiliated Computer Services (ACS), a Xerox Company.
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