A Manpower Policy for Primary Health Care Report of a Study (1978) / Chapter Skim
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Chapter 4: The Supply and Distribution of Primary Health Care Practitioners
Chapter 4: The Supply and Distribution of Primary Health Care Practitioners
Pages 41-66
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From page 41... ...
Empirical research to date suggests that use of physician assistants and nurse practitioners and allied health manpower increases the productivity of a physician practice. 5/ Similar results have also been obtained for the use of some types of medical equipment.
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From page 42... ...
Originally, nurse practitioners and physician assistants were seen as a way of speedily increasing the supply of personal health services. In less than two years, training programs could turn a registered nurse or an individual with some health care experience, such as an ax-military corpsman, into a provider of quality medical services.
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From page 43... ...
Options and Recommendations The committee considered three policy options for the training of physician assistants and nurse practitioners: increasing, decreasing, or maintaining the numbers trained at the current annual level. The committee rejected the option of increasing the number of physician assistants and nurse practitioners being trained, partly because the expected increase in the supply of physicians might limit the employment of the new health practitioners.
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From page 44... ...
20/ Moreover, research findings indicate that nurse practitioners and physician assistants can provide a range of medical services at a level comparable in quality to that of physicians. 21/ THE SUPPLY OF PHYSICIANS IN PRIMARY CARE DISCIPLINES Although physicians are only one group of providers of primary care, the special role of physicians in the health care system makes their availability extremely important.
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From page 45... ...
As a workable policy the committee explored a fourth strategy of changes related to reimbursement for the delivery of primary care. The enactment of national health insurance legislation would also have direct and indirect consequences for the supply of primary care physicians.
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From page 46... ...
Capitation requires paying the physician for the number of patients he or she is responsible for during a period of time. However, fee-for-service, that is, payment for each service delivered, is still the prevalent method of paying physicians: 71 percent of non-federal patient care physicians are paid by the fee-for-service method.
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From page 47... ...
Fee schedules are determined by a survey of physician's billed charges, through negotiations between insurance companies and medical societies, or, as is done by most state Medicaid agencies, by applying a dollar conversion factor to a relative value system. 36/ Relative value systems establish a quantitative but nonmonetary scale on the worth of one procedure as compared to all other procedures.
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From page 48... ...
Options and Recommendations Payment practices of third-party payors place no premium upon the delivery of primary care and in fact may discourage physicians from specializing in primary care disciplines. Thus, to increase the availability and quality of primary care services, the committee recommends changes in the structure and practices of reimbursement methods.
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From page 49... ...
The assignment of a managerial role to the primary care physician would provide a level of cost and quality control, more clearly separate physicians into primary and referral specialist roles, and provide an operational mechanism for providing reimbursement to all physicians, whether a primary care physician or not, for performing primary care services. There are unresolved issues in using this approach, including whether -49
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From page 50... ...
The second option was dismissed, because the additional payment for primary care services might produce the necessary additional primary care services and attract more physicians into primary care disciplines, but it would increase the costs of health care. An intermediate course, and the one adopted by the committee, is to reduce the differentials between procedures.
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From page 51... ...
Empirical evidence indicates cigarette smoking is a causative factor in lung cancer, chronic bronchitis, emphysema, ischemic heart disease, and obstructive peripheral vascular disease. Cigarette smoking is considered to be the direct cause of 80 percent of the 80,600 deaths due to lung cancer in 1975 46/ The economic burden of cancer is high as well.
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From page 52... ...
The committee believes that on balance the expected increases in length and quality of life compensate for the increased use of primary health care services. GEOGRAPHIC DISTRIBUTION OF PRIMARY CARE PRACTITIONERS Physicians in primary care disciplines, like physicians in general, are unevenly distributed among geographic areas.
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From page 53... ...
57/ In addition, given the evidence on the inadequate distribution of physicians in primary care disciplines and recognizing the contribution of physician assistants, nurse practitioners, and family physicians in delivering primary care in underserved areas, the committee recommends that (Recommendation #7) training programs for family physicians, nurse practitioners, and physician assistants should continue to receive direct federal, state, and private support, beca most feasible providers of primary care to underserved populations.
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From page 54... ...
should discontinue all geographic differentials in payment levels for physician services within a state. The other options considered by the committee include: Third-party payors (federal, state, and private)
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From page 55... ...
Moreover, the committee favored equal payment in its belief that some underserved rural areas may have lower costs for providing medical services, such as rent and salaries, and hence identical payments would act as incentives to the delivery of primary care in these areas. The second option, which establishes higher payment levels for the provision of primary care services in rural underserved areas, would be an incentive to provide primary care in these areas.
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From page 56... ...
70/ The pattern of non-reimbursement for primary care services furnished by nurse practitioners and physician assistants is inconsistent with public policy that promotes the distribution of primary care practitioners in underserved areas. Therefore, the committee recommends that (Recommendation #9)
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From page 57... ...
geographic distribution of physicians, nurse practitioners, and physician assistants,and also for monitoring the perce . Lion regarding the adequacy and availability of primary care services.
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From page 58... ...
Moreover, to facilitate this research, accurate data is needed on the use of specific primary care services, the efficacy of primary care procedures, and the differing roles of primary care practitioners. In addition, further work on the quality of primary care, the cost and efficacy of the delivery of primary care in different practice arrangements, team delivery of primary care, and the effect of reimbursement policies and credentialing on the providers of primary care is needed.
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From page 59... ...
Mason, Physician Distribution and Medical .icensure in the U.S.. 1975 (Chicago, American Medical Association: 1976~; see also staff paper, "Data on the Supply and Distribution of Primary Care Physicians." American Association of Colleges of Osteopathic Medicine, "Osteopathic Medical Manpower Information (OMMI)
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From page 60... ...
Scheffler, "The Productivity of New Health Practitioners: The Physician Assistant and Medex" in Health Manpower, Vol.
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From page 61... ...
Workers. See staff papers, "Consumer Acceptance of Nurse Practitioners and Physician Assistants" and "Physician Acceptance of Nurse Practitioners and Physician Assistants." 22.
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From page 62... ...
24. See staff paper, "Data on the Supply and Distribution of Primary Care Physicians." 25.
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From page 63... ...
W.S. Sobaski, "Effects of the 1969 California Relative Value Studies on Costs of Physician Services Under SMI," Health Insurance Statistics 69, Office of Research and Statistics, Social Security Administration, U.S.
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From page 64... ...
54. Scheffler, "The Supply and Demand for New Health Professionals: Physician Assistants and Medex"; Harry Sultz, Marie Zielezny and Louis Kinyon, "Highlights: Phase 2 of a Longitudinal Study of Nurse Practitioners," State University of New York at Buffalo, New York, 1977 (mimeographed)
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From page 65... ...
Seven states permit payment for medical services provided by nurse practitioners and physician assistants as 'services provided...by or under the personal supervision" of a licensed physician. See staff paper, "Public Payment for Primary Care Services." 69.
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From page 66... ...
71. See staff papers, "Consumer Acceptance of Nurse Practitioners and Physician Assistants" and "Physician Acceptance of Nurse Practitioners and Physician Assistants," and Cohen, et.
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