All Health Working Papers are now available through the OECD's Internet Website at http:/www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language -English or French -with a summary in the other.Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France.The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. ABSTRACTMany countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors. This paper reviews the development of advanced practice nurses in 12 countries (Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States), with a particular focus on their roles in primary care. It also reviews the evaluations of impacts on patient care and cost.The development of new nursing roles varies greatly. The United States and Canada established "nurse practitioners" in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. Although development in Australia and Ireland is more recent, these two countries have been very active in establishing higher education programmes and posts for advanced practice nurses in recent years. In other countries, the formal recognition of advanced practice nurses is still in its infancy, although unofficial advanced practices may already exist in reality.Evaluations show that using advanced practice nurses can improve access to services and reduce waiting times. Advanced practice nurses are able to deliver the same quality of care as doctors for a range of patients, including those with minor illnesses and those requiring routine follow-up. Most evaluations find a high patient satisfaction rate, mainly because nurses tend to spend more time with patients, and provide information and counselling. Some evaluations have tried to estimate the impact of advanced practice nursing on cost. When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses' salaries -as opposed to doctors -can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing.Keywords: nurses, advanced roles, skills, nurse practitioners, clinical nurse specialists, primary care, OECD countrie...

All Health Working Papers are now available through the OECD's Internet Website at http://www.oecd.org/health/workingpapers JT03342429 Complete document available on OLIS in its original format This document and any map included herein are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.

JT03260782 OECD HEALTH WORKING PAPERSThis series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language -English or French -with a summary in the other.Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France.The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. ABSTRACTMost OECD countries have endorsed as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to health care based on need. These policy objectives require an evidence-based approach to measure progress. This paper assesses the availability and comparability of selected indicators of inequality in health status and in health care access and use across OECD countries, focussing on disparities among socioeconomic groups. These indicators are illustrated using national or cross-national data sources to stratify populations by income, education or occupation level. In each case, people in lower socioeconomic groups tend to have a higher rate of disease, disability and death, use less preventive and specialist health services than expected on the basis of their need, and for certain goods and services may be required to pay a proportionately higher share of their income to do so.Options for future OECD work in measuring health inequalities are provided through suggesting a small set of indicators for development and inclusion in the OECD Health Data database. Some indicators appear to be more advanced for international data collection, since comparable data are already being collected in a routine fashion in most OECD countries. These include the indicators of inequalities in selfrated health, self-rated disability, the extent of public health care coverage and private health insurance coverage, and self-reported unmet medical and dental care needs.Increased availability and comparability of data will improve the validity of cross-national comparisons of socioeconomic inequalities in health status and health care access and use. Harmonisation of definitions and collection instruments, and the greater use of data linkages in order to allow disaggregation by socioeconomic status, will determine whether health inequalities can be routinely monitored across OECD countries.

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