Using the 1996 Medical Expenditure Panel Survey Household Component, this study examines the proportion of ambulatory care visits seen by nurse practitioners (NPs) and physician assistants (PAs) relative to physicians in rural managed care (MC) settings, compared with rural traditional (non-MC) settings. Ambulatory visits are based on counts of the number of medical events as office-based visits and hospital outpatient department visits, reported in the three rounds of interviews occurring in 1996. The rural residents were retrieved and grouped into 3 groups based on insurance types: Medicaid, Medicare, and Private Insurance. The result showed that the proportion of patients seen by rural NPs and PAs in Medicaid Managed Care (MMC) was twice that in Non-MMC sector (9.4% versus 4.5%). Impressively, this pattern holds for all of the four census regions. This was not true of Medicare and Private Insurance, however, probably due to the current low penetration rate of managed care in rural Medicare and private insurance sectors. Although we can not say that there were new additions of NPs and PAs in MMC areas, at least we can say that MMC increased access to care by increasing the number of NPs and PAs, relative to physicians, participating in MMC programs. A close monitoring of implementation of the Balanced Budget Act of 1997, which facilitates the expansion of Medicaid and Medicare managed care into rural areas, is needed to ensure a faster expansion of managed Medicare and MMC into rural areas.
Learning Objectives: 1. Identify the effect of managed care on the utilization and mix of different rural health care providers. 2. Learn the importance of increasing the supply of nurse practitioners and physician assistants in rural communities, which confront increasingly-severe competition for primary care practitioners with urban communities
Keywords: Managed Care, Rural Health Service Providers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.