What Impact Will Nurse Practitioners Make on Containing Escalating Costs in Health Care?
Nurse practitioners (NPs) are a proven response to the evolving trend towards wellness and preventive health care driven by consumer demand. A solid body of evidence demonstrates that NPs have consistently proven to be cost-effective providers of high-quality care for almost 50 years. More than three decades ago, in 1981, the Office of Technology Assessment (OTA) conducted an extensive case analysis of NP practice, reporting that NPs provided equivalent or improved medical care at a lower total cost than physicians. NPs in a physician practice potentially decreased the cost of patient visits by as much as one-third, particularly when seeing patients in an independent, rather than complementary, manner. A subsequent OTA analysis in 1986 confirmed original findings regarding NP cost effectiveness. All later studies of NP care have found similar cost efficiencies associated with NP practice.
Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study. Ambulatory care encompasses a broad range of personal healthcare services that do not require an overnight hospital stay. This is the defining feature of ambulatory care, not the setting or type of service, both of which are quite varied. Settings can be community or hospital based. Services can include diagnosis, observation, monitoring, consultation, prevention, treatment, rehabilitation, and diagnostic, therapeutic or surgical procedures. This paper focuses on ambulatory primary care and ambulatory specialty care. We define the former as a full range of comprehensive services, including diagnosis and treatment of undifferentiated health problems longitudinally over time and the latter as focused services for a specific population with the same condition or need for specific services. Improving the quality of ambulatory care services within a value for cost framework is a world-wide challenge. In response, new healthcare provider roles have been developed and existing roles adapted. Introduced in North America more than 50 years ago, nurse practitioners carry out a range of activities, some of which overlap with activities traditionally performed by physicians. The extent to which nurse practitioner roles are autonomous or supervised varies within6 and across5 countries, and their acceptance by physicians is inconsistent.
Although the literature suggests that nurse practitioners increase access to healthcare services and provide equal or superior quality of care as compared to physicians, there is little synthesis on the cost-effectiveness of nurse practitioners. As a foundation for meaningful health reform, cost-effectiveness analysis provides estimates of the magnitudes of costs and health outcomes. In this context, the cost-effective outcome is the least expensive labor input to produce healthcare services with the desired clinical result (Bauer 2010). By evaluating outcomes and costs of interventions designed to improve health, cost-effectiveness analysis serves as a guide to resource allocation. Cost-effectiveness analysis illuminates the opportunity cost of each choice, providing decision makers with the necessary information to make informed judgments (Weinstein et al. 1996). Currently, there is no clear consensus on the cost-effectiveness of nurse practitioners, as there has not been a rigorous synthesis of available data. The synthesis of existing information on nurse practitioner cost-effectiveness is necessary to inform healthcare policy and nurse practitioner scope of practice regulations, as well as public, organizational, and educational policy. Quality is the most important consideration in healthcare delivery. Nurse practitioners have been demonstrated to provide equal or superior quality of care as compared to physicians, especially in the areas of wellness and prevention services, diagnosis and management of common uncomplicated acute illnesses, and management of chronic diseases.
All things considered, capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing and beneficial. This review suggests that the implementation of the NP/APN role in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.
Bauer, J. C. 2010. Nurse practitioners as an underutilized resource for health reform: Evidencebased demonstrations of cost-effectiveness. Journal of the American Academy of Nurse Practitioners 22 (4): 228-231.
Bissinger, R. L., Alford, C. A., Arford, P. H., and Bellig, L. L. 1997. A Cost-Effectiveness Analysis of Neonatal Nurse Practitioners. Nursing Economics 15 (2): 92-99.
Starck, P. L. 2005. The cost of doing business in nursing education. Journal of Professional Nursing 21 (3): 183-190.
Weinstein, M. C., Siegel, J. E., Gold, M. R., Kamlet, M. S., and Russell, L. B. 1996. Costeffectiveness in health and medicine. New York: Oxford University, 55.