Study raises concerns over co-payments.
Subject: Practical nurses (Practice)
Medical consultation (Management)
Physicians (General practice) (Practice)
Pub Date: 08/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2010 Source Volume: 16 Source Issue: 7
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Product: Product Code: 8043120 Nurses, Practical NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 236247976
Full Text: Nurses would be very concerned if GP employers decided to raise the co-payments for nurses as a result of a study into the cost effectiveness of practice nurses. The study into the financial impact of task substitution between nurses and GPs, published on the Ministry of Health's website earlier this month, found that general practices could make more money by using practice nurses to provide more primary health care(PHC), including straightforward consultations.

Chair of the NZNO College of PHC Nurses, Rosemary Minto, said the study confirmed the cost effectiveness of practice nurses. "If all practice nurses were empowered to work to their full potential, there would be considerable cost savings in PHC. But we would be very concerned if employers raised co-payments for nurses as a result of the study, as this would reduce access and affordability for clients," she said.

The study found that practices could increase their co-payments for nurse consultations and/ or reduce their fees for GP consultations in order to improve the cost effectives of task substitution. "In many cases, nurse fees need to be at 50 percent or more of GP fees for substitution to be worthwhile," the study report stated.

The study of nine general practices included details of more than 2000 consultations. In two of the practices, both very low cost access, nurses were providing up to 50 percent of the total clinical consultations. Nursing roles varied markedly between the practices studied, both in the proportion of nurse consultations and the breadth of the nursing roles but there was substantial commonality. Nurses are doing most immunisations, are leading the care of those with long-term conditions and, in some practices, have an emergent role in managing acute/ walk-in patients. Of the nine practices, one was owned by a chain provider, one by a district health board, two were community-owned and the remainder were GP-owned.

The study did not look at the relative quality of nurse vs GP consultations but stated latest research indicated equivalent or superior outcomes for nurse consultations in primary care.

A computer model with an assumed GP hourly rate of $80 plus five percent for education and leave etc, generated a cost per working minute of $1.75. A nursing hourly rate of $29 an hour generated a cost per worked minute of 59 cents. "Nurse cost per minute is 34 percent of GP cost per minute. Given this ratio, all other things being equal, it will always be more cost effective to use a nurse to deliver a given service," the report stated.
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