Impact of Nurse Practitioner Practice Regulation on Access to Healthcare Services

Abstract

Nurse practitioner (NP) practice regulations vary from state to state across the United States. Despite strong evidence supporting the quality of care and satisfaction with care provided by NPs, restrictive regulations continue to limit the practice of NPs in many states. Given current and growing physician shortages, particularly in the area of primary care, NPs are in a role to fill critical gaps in the current healthcare delivery system. The following dissertation examines the impact of state NP practice regulations on access to care. The specific aim of this study is to examine the relation between different levels of state NP practice regulation and access to care in the Medicare population. The design of the study is a secondary data analysis of the Medicare Current Beneficiary Survey, Access to Care 2011 dataset. Data for this dataset were collected during the fall 2011 interview session, and represent a cross-sectional sample. An observational method is used to examine the impact of state nurse practitioner practice regulations (restricted, reduced, and full nurse practitioner practice) on the following dependent variables which measure access to healthcare services: appointment waiting times (continuous variable measured in number of days to get appointment, and number of minutes spent waiting at an appointment to see a provider), difficulty accessing care (categorical variable), and usual source of care categorical variable). Ron Andersen’s Theoretical Framework for Measuring Access to Medical Care is used as a guiding framework to theoretically define and operationalize the dependent variable of access to healthcare services. SAS survey procedures were used to apply Taylor series weights to all statistical analyses in order to make data and results representative of the “always enrolled” Medicare beneficiary population (N = 15,027, weighted sample = 45,205,096). Descriptive statistics are given to describe the population of interest. Covariates used in the regression analysis were: urbanicity, nursing home stay, Medicaid HMO coverage, and private insurance coverage. Results of the regression analysis for appointment waiting time (time to get an appointment) were least favorable for participants in Full NP practice groups. No significant effect was seen in the time spent waiting at an appointment to see a provider. Difficulty encountered accessing care was statistically significant, with participants in Full NP practice states experiencing increased difficulty getting from home to the provider office. Additionally, participants in Restricted and Reduced NP practice states were more likely to report having trouble accessing care due to cost than participants in Full NP practice states. No significant effect was seen in logistic regression analysis for usual source of care. A higher percentage of participants in Full NP practice states seek care at HMOs for their site of care. Several limitations exist, including lack of control over primary data collection and high percentages of missing data for some items on the survey. Future research is needed to examine access to care in response to NP practice in other populations (private insurance, uninsured, and HMO groups), and compare access to care before and after NP practice regulation health policy change. NP involvement in health policy change is critical during this time of rapid reform