In our data, increased use of nonphysician providers
is not associated with better screening or monitoring measures, reduced levels of avoidable utilization, increased Medicare revenue (risk-adjusted cost), or improvements in net revenue.
In a state by state survey conducted in 1992, the Physician Payment Review Commission reported that many state Medicaid programs were not covering nonphysician providers
to the extent those states' practice acts permitted.
We exploit state-level variation in Medicaid expansion using difference-in-differences methods to estimate changes in the probability of having any office-based visits to primary care physicians, specialists, and nonphysician providers
. We also provide unique estimates of effects on visits to two types of nonphysician providers
: (1) nurse practitioners, nurses, and physician assistants', and (2) other nonphysician providers
With workforce modifications and cost containment major issues in health care delivery, the use of nonphysician providers
has steadily increased in both primary care and specialty practices.[1-5]
Efforts to provide medical information to the non-academically based provider are increasing in numbers; studies such as Ellen Hall's (1995) indicate that nonphysician providers
, such as physical therapists, have an increased need for medical information as they branch out from hospital-based practices to private practices.
Some experts have raised concerns about an oversupply of specialists who rely heavily on government funding for training, while, at the same time, licensure laws and Federal reimbursement regulations restrict nonphysician providers
from entering the health care marketplace.
If we had the missing information [about how nurse practitioners provide care], perhaps we could argue for policies that would support the professional autonomy of nonphysician providers
and broaden the scope of their practice without reinforcing the sexual division of labor market.
Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPS and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers
, educators, and administrators.
universal coverage, preventive health care, cost containment through managed care, extensive use of nonphysician providers
, and an emphasis on what's medically effective for our citizens" (Washington Post, 20 March 1993).
Furthermore, some of the productivity gains that have been achieved through the use of lower-cost providers as a substitute for physician care within physician practices may be less pronounced in the future, because of limitations such as licensing restrictions on the scope of care that may be provided by nonphysician providers
"It says that services that are delegated to and provided by nonphysician providers
under physician supervision must be provided with the same quality and should be reimbursed at the same level as services directly provided by a physician."
A portion of what is gradually occurring is the rapid adoption of technologies and the progressive implementation of not only expanded responsibilities for nonphysician providers
but also an expanded number of nonphysician clinicians involved with patient care.