Improving Health Care Access While Cutting Costs

Is it possible to improve health care access while also cutting a costs? Yes—according to a recent study by Edward Timmons of the Mercatus Center.

Writing in U.S. News and World Report, Timmons explains that expanding the scope of practice for physician assistants and nurse practitioners can significantly reduce health costs and Medicaid expenditures:

Utilizing Medicaid claims data, I find evidence that an expanded scope of practice is indeed associated with lower health care costs. More specifically, the cost of outpatient claims per Medicaid beneficiary is about 11 percent lower in states where physician assistants are permitted to prescribe drugs.

Occupational licenses, which vary from state to state, define the scope of practice—or services a health care worker can provide to patients. Because Medicaid reimbursement rates are lower for physician assistants and nurse practitioners, expanding their scope of practice results in significant cost savings for state government.

In Pennsylvania, physician assistants are permitted to prescribe controlled substances, but nurse practitioners are required to prescribe under the direct supervision of a physician. Timmons suggests that services exclusively left to doctors are not worth the costs:

While it makes sense that only a brain surgeon should perform brain surgery, some of these laws appear to exist predominantly for medical doctors to preserve their market share. Although there are a number of factors contributing to rising health care costs, turf wars between competing health care providers are certainly not improving the situation.

Importantly, the study finds that expanding scope of practice will not reduce health quality. 

Lorraine Bock, president of the Pennsylvania Coalition of Nurse Practitioners, describes how patients are the ones who suffer from the status-quo:

A few years ago, a nurse practitioner from Venango County drafted a letter to her patients. “I am sorry this is happening,” she wrote. “I have enjoyed your friendship and trust. We have become friends over the years and I will treasure these times forever.”

After 10 years, she had to break the news that her rural Oil City practice was closing its doors. Not because she wasn’t seeing enough patients. To the contrary, her willingness to waive co-pays for low-income patients meant that her waiting room was seldom empty. The problem was a state law that prohibited her from serving her patients after her partner, a physician, withdrew from the business without warning. For many of her patients that meant a two-hour round trip to the second-nearest provider.

House Bill 765 and Senate Bill 717, currently pending in the state Capitol, would allow Pennsylvania to join nearly two dozen states which permit nurse practitioners to practice with autonomy. Not only will these bills increase access to care, they will result in significant savings to the state budget—truly a win-win for health care consumers and taxpayers.