The Case For More Nurses and Physician Assistants

With much people still talking about healthcare reform I thought there was one area thing people were not talking about: nurse practitioners (NPs) and physician assistants (PAs). I see both of these professions doing mountains of paperwork and it seems as if they are not being put to their highest valued use: helping and serving patients. States like Texas nurses practitioners are required to have a doctor sign off on 10% of the charts. However, 34 states don’t have this requirement. Not only does this waste time for the nurse practitioner but also takes time away from the doctor who is trying to help patients. There is an expected shortage of doctors (expected to grow to 130,000 by 2025) however there are some issues with this.  Why not add 155,000 nurse practitioners and over 83,000 physician assistants? So let’s assume that only 90% of nurse practitioners and physicians assistants are working with patients. If they on average see 8 patients a day that means 1.7 million more people per day could see a medical professional! Every week that would be close to 11.99 million who would have access to someone who could help them.

Much of the criticism comes from people who say things like “Nurse practitioners and physicians are not as qualified as doctors”. Sometimes things that seem true are not true once you look at the evidence. What is fascinating is this article in The Journal of the American Medical Association from January 2000 entitled “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians a Randomized Trial” the study concluded that even when patients were randomly assigned to either a nurse practitioner or doctor the outcomes were comparable. What is even more fascinating is that the patients with hypertension did better under the care of the nurse practitioners than doctors.

Perhaps the real icing on the cake is that the American Medical Association would publish this considering it has a vested interest no one other than doctors see patients. A 2000 RAND study found no evidence that nurses provided lower quality care than their counterparts and actually could reduce office visits by 35%. This case study showed that in the late 1990's when nurse practitioners were introduced to Loyola University for their cardiovascular program the mortality rate decrease from 3% to .9% in only 4 years, complication rates decreased, and the costs also decreased. This study in a 2 year follow up found that there was no difference between the care physicians provided and that of nurses. This study showed that nurses and PAs provided similar care as HIV experts and even better care than non-HIV experts.

Women’s right activists should embrace more this since nurses make up 92% of all nurses. By giving the women in this field more responsibilities it will increase their pay which I see as positive. The elitist view view that only doctors can help people is such utter nonsense.  Medical information is more dispersed now than ever before. States and the AMA should allow nurse practitioners and physician assistants to provide care. As I mentioned the level of care is similar to that of a physician, healthcare costs would be reduced, statistically speaking women would be given more responsibilities and in turn make more money. I see all of these things as positive. The only people who wouldn’t like this are people who would have to compete with these “new” medical professionals. 

Surgery Center of Oklahoma: First and Only Free Market Hospital in America

I saw this recent video about the Surgery Center of Oklahoma which may be in fact the only free market hospital in America if not the world. I blogged about the hospital in this post.  What is interesting is that the hospital actually posts prices for surgeries. What I found interesting was the hospital also published infection rates which I don’t see regular hospitals do. In the investment industry fund managers post data like risk, return, and other important data. Why don’t hospitals, physicians and surgeons do the same? As long as the insurance company is picking up the bill do patients really have that much incentive to care? By the way the Surgery Center of Oklahoma has a lower infection rate of a mere .001% which is much lower than the national average of 2.6%. Hospitals hire administers which can be in the six figure range and really just handle paperwork. I am amazed when I go to a doctor why they ask me the same questions (even after I have been to the same doctor for years). Never mind the fact that there is a staff just talking to insurance companies and filling out paperwork. Is this really making us better off? I would say no. Healthcare is not run like a business. What we need is more hospitals like Surgery Center of Oklahoma which don’t take insurance and inform patients of what the prices are. If you had more hospitals like this they would have to compete not only on price but also quality as well. This would be great for patients and lead to some advancements as doctors would try new things to improve care and reduce the risk for the patient. I notice we don’t need an Affordable Food Care Act, Affordable Computer Care Act, or Affordable Video Game Act. Food, computers, and video games operate in a free market where competition increases quality and lowers prices. Healthcare is not a free market by any means. Can you think of any think the government provides that is of higher quality and cheaper than the private sector? Economist Dr. Walter E. Williams summed it up with his own Williams’ law which states: whenever the profit incentive is missing, the probability that people’s wants can be safely ignored is the greatest.

H/T- Carpe Diem

Obamacare and Healthcare

Today the Supreme Court ruled in a 5-4 decision that the government can force people to buy health insurance. What the Supreme Court did in essence is place a tax on people for not doing something. The legislation entitled Patient Protection and Affordable Care Act plans to try to provide more people with health insurance. I like the key word “affordable”. If you ask someone what is the cost of an affordable house, college, or health insurance could they give you a number? The AMA endorsed the plan in this press release. According to a Gallup Poll done in December 2011 around 17.7% of Americans didn’t have health insurance. This turns out to be close to 50 million people. However, this paints a false picture. Around 25% of these people who are counted as uninsured can get Medicaid and the State Children’s Health Insurance (S-SHIP) but never enrolled. Another 20% of the people who are counted as uninsured are not legal immigrants. Also greater than 33% of people have incomes over $66,000 yet many choose not to purchase healthcare since they are young. Also a very small percentage of people (2.6%) of people go without health insurance for three years or longer.

Another big question is about pre-existing conditions. I would say on this there are some people who through no fault of their own have conditions that they had no fault in causing. However, the idea of insurance is to plan for unforeseen events. One problem is that health insurance is often tied to employment. You can’t take your health insurance policy with you from company to company since the company is paying for it. A better system would be companies just to increase the pay by the amount of what the insurance is worth and let consumers purchase their own health insurance. Also since people can’t purchase health insurance across state lines it artificially increases in the price of insurance. This requires insurance companies to comply with different regulations and restrictions which impose costs on them which are passed on to the consumer. If you don’t believe that there is much regulation in insurance can you even name three new insurance companies in the past five years?

The government does a poor job of managing the money taxpayers give it. Medicare fraud is estimated at $48 billion for 2010. Total spending on Medicare was around $528 billion which means 9% of spending on Medicare is payments to bogus people. If any private organization had a business like this they wouldn’t even exist. If people were paying with their own money instead of a third party paying this wouldn’t occur. Speaking of Medicare according to this article the last two months of a patient’s life cost Medicare $55 billion and it estimated that 20%-30% of the expenses have no impact yet the government keeps spending money.  

The idea of free markets is to create competition which drives down prices and increases options which would allow more people to have health insurance. Two other things that increase cost as I have pointed out here and here the lack of not enough private hospitals and FDA also increase the cost of healthcare. If we had more hospitals it would increase competition and bring down costs. The FDA limits the type of drugs that can go on to the market which artificially increases the price since drugs that the FDA doesn’t approve will never end up in the hands of patients even though some people in the clinical trials benefit. Allow patients to use drugs after the drugs were tested for safety in Phase I and you would see more innovation and prices for drugs drop like a rock. Healthcare isn’t complex we just need more free market solutions.