University of Pennsylvania School of Nursing, Philadelphia, PA.
University of Pennsylvania School of Nursing, Philadelphia, PA.
Nurs Outlook. 2018 Nov;66(6):551-559. doi: 10.1016/j.outlook.2018.05.004. Epub 2018 Jul 11.
The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines. This paper examines the effects of nurse practitioner collaborative practice agreements and similar models of health professional regulation, defined as legally required supervision, on the cost and delivery of health services. A policy analysis examines empirical, policy, and law literature between two health professionals providing a similar service. Analysis includes literature on dental hygienists, dentists, certified registered nurse anesthetists, midwives, nurse practitioners, physicians, and pharmacists. A framework for legally required supervision across health professionals is presented. Antecedents of legally required supervision include occupational licensure, reimbursement policy, and institutional policy. Legally required supervision inhibits provider entry to practice and the production of health services by supervised providers. The cost of care increases under legally required supervision. Costs are measured by wages for providers and the price of services for patients. This paper and proposed framework summarize the antecedents and consequences of legally required supervision. Discipline-specific antecedents and provider characteristics must be considered when calculating the full effect of legally required supervision on the delivery and cost of health services.
合法要求的监督在提供类似服务的卫生专业人员中普遍存在。合法要求的监督有可能破坏跨学科领域高质量、具有成本效益、可及的卫生服务的提供。本文考察了护士执业者合作实践协议和类似的卫生专业人员监管模式（定义为合法要求的监督）对卫生服务的成本和提供的影响。一项政策分析审查了在提供类似服务的两名卫生专业人员之间的实证、政策和法律文献。分析包括关于牙科保健员、牙医、注册麻醉师、助产士、执业护士、医生和药剂师的文献。提出了一个跨卫生专业人员的合法要求监督框架。合法要求监督的前因包括职业许可、报销政策和机构政策。合法要求的监督抑制了提供者的执业进入和受监督提供者的卫生服务的提供。在合法要求的监督下，护理成本增加。成本由提供者的工资和患者服务的价格来衡量。本文和拟议的框架总结了合法要求监督的前因和后果。在计算合法要求的监督对卫生服务的提供和成本的全部影响时，必须考虑具体学科的前因和提供者特征。
