How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants

Stange, Kevin

doi:10.1016/j.jhealeco.2013.10.009

Cited by 108 publications

(118 citation statements)

References 44 publications

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“…However, Stange (2014) found that the expansion of NP SOP regulation did not affect office-based visit price, which was measured as the total charges per visit. As explained by the author, this finding might be due to a noncompetitive primary care market in which current reimbursement-driven policies involve rigid pricesetting, restrictions in NP service reimbursement, and incentives for physician involvement to bill at a higher rate.…”

Section: Impact Of State Np Sop Regulation On Health Care Costsmentioning

confidence: 96%

“…Consistent evidence has shown that the number of NPs and growth of the NP workforce were highest in states with greater practice authority. Evidence from four studies indicates that states with more favorable NP practice environments have higher per capita NPs (Auerbach, 2000;Kuo et al, 2013;Reagan & Salsberry, 2013;Stange, 2014). By 2010, states with full SOP regulations had an average of 25 more NPs per 100,000 population (95% confidence interval [1.2, 48.3]) compared with states with the most restrictive SOP regulations (Kuo et al, 2013).…”

Section: The Impact Of State Sop Regulation On Np Workforcementioning

confidence: 99%

“…Only a single study, conducted by Stange (2014) examined the impact of state NP SOP regulations on primary care access and utilization; fortunately, the study was rigorously designed and provided insightful results. Access to care was defined as whether an individual had a usual source of care, and health care utilization was examined as the number of officebased visits (primary care, nonprimary care and overall) and use of preventive care services, such as getting a flu shot, checking blood pressure or cholesterol, having a breast examination, or having a pap smear, in the past 12 months.…”

Section: The Impact Of State Sop Regulation On Care Provision By Npsmentioning

confidence: 99%

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Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

et al. 2016

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a b s t r a c tBackground: One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations. Purpose: The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs. Methods: Systematic review. Results/Discussion: States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP. Conclusions: Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.

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Section: Impact Of State Np Sop Regulation On Health Care Costsmentioning

confidence: 96%

Section: The Impact Of State Sop Regulation On Np Workforcementioning

confidence: 99%

Section: The Impact Of State Sop Regulation On Care Provision By Npsmentioning

confidence: 99%

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Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

et al. 2016

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“…7 Thus, primary care is being transformed into care delivered in teams comprised of clinicians from multiple disciplines, including nurse practitioners (NPs) and physician assistants. 8,9 Policy recommendations are supportive of this trend as a means to increase access, improve care, and control costs. 10,11 To achieve these goals, primary care practices are implementing team-based models to optimally utilize the available workforce.…”

Section: Introductionmentioning

confidence: 99%

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Poghosyan

Liu

2016

J GEN INTERN MED

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BACKGROUND:The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians. OBJECTIVE: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. DESIGN: Using a cross-sectional survey design, data was collected from 163 p ri mary care practices in Massachusetts. PARTICIPANTS: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %. MAIN MEASURES: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale. KEY RESULTS: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model. CONCLUSION: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.

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“…One study found that total spending on office visits (that is, all office-based settings for physician and APN care) was 4.3 per cent higher in states with full practice authority than in states with scope of practice restrictions (Stange, 2014). However, increases in spending related to greater access to primary and preventive care could be offset by savings from reduced utilization in more intensive settings; for example, one study found reductions in ambulatory-sensitive emergency department visits (Traczynski & Udalova, 2013).…”

Section: Discussionmentioning

confidence: 99%

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Hussey¹,

Ringel²,

Ahluwalia³

et al. 2015

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How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants

Cited by 108 publications

References 44 publications

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

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