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How do non-physician providers function in HMOs?
HMO Practice
|November 4, 1994
Summary
The effectiveness of non-physician providers, including nurse practitioners (NPs) and physician assistants (PAs), is being examined for future healthcare reform. Evidence suggests NPs can function effectively, particularly in collaborative primary care settings.
Area of Science:
- Healthcare policy and delivery systems
- Primary care and workforce studies
Background:
- Healthcare reform emphasizes a primary care model, necessitating a shift from specialty-focused systems.
- Increased utilization of nurse practitioners (NPs) and physician assistants (PAs) is noted in current healthcare delivery.
- Concerns exist regarding the cost-effectiveness and independent practice capabilities of non-physician providers.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of non-physician providers in primary care.
- To address questions about the future roles of NPs and PAs within reformed healthcare systems.
- To analyze existing evidence on the performance of mid-level clinicians.
Main Methods:
- Meta-analysis of over 30 studies on non-physician provider effectiveness.
- Review of literature concerning the roles and projected utilization of NPs and PAs.
- Analysis of studies conducted in managed care and university settings.
Main Results:
- A meta-analysis indicates the effectiveness of non-physician providers.
- Most studies reviewed were conducted in managed care or academic settings.
- NPs in these studies often worked collaboratively within physician-led teams.
Conclusions:
- Non-physician providers, particularly NPs, demonstrate effectiveness in healthcare delivery.
- The majority of evidence supporting NP effectiveness comes from collaborative practice models.
- Further research may be needed to assess the utility of older studies and independent NP practice.