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Is it economically viable to employ the nurse practitioner in general practice?

Authors

  • Angelique TM Dierick-van Daele,

    1. Authors:Angelique TM Dierick-van Daele, MSc, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, Maastricht; Lotte MG Steuten, PhD, Senior Researcher, Department of Health Technology and Services Research, University Twente, Enschede; Arla Romeijn, MSc, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht; Emmy WCC Derckx, MSc, Project Leader, NPGP Study and CEO of the Foundation for Development of Quality Care in General Practice, Eindhoven; Hubertus JM Vrijhoef, PhD, Professor of Chronic Care, Department of Integrated Care, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht and Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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  • Lotte MG Steuten,

    1. Authors:Angelique TM Dierick-van Daele, MSc, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, Maastricht; Lotte MG Steuten, PhD, Senior Researcher, Department of Health Technology and Services Research, University Twente, Enschede; Arla Romeijn, MSc, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht; Emmy WCC Derckx, MSc, Project Leader, NPGP Study and CEO of the Foundation for Development of Quality Care in General Practice, Eindhoven; Hubertus JM Vrijhoef, PhD, Professor of Chronic Care, Department of Integrated Care, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht and Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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  • Arla Romeijn,

    1. Authors:Angelique TM Dierick-van Daele, MSc, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, Maastricht; Lotte MG Steuten, PhD, Senior Researcher, Department of Health Technology and Services Research, University Twente, Enschede; Arla Romeijn, MSc, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht; Emmy WCC Derckx, MSc, Project Leader, NPGP Study and CEO of the Foundation for Development of Quality Care in General Practice, Eindhoven; Hubertus JM Vrijhoef, PhD, Professor of Chronic Care, Department of Integrated Care, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht and Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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  • Emmy WCC Derckx,

    1. Authors:Angelique TM Dierick-van Daele, MSc, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, Maastricht; Lotte MG Steuten, PhD, Senior Researcher, Department of Health Technology and Services Research, University Twente, Enschede; Arla Romeijn, MSc, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht; Emmy WCC Derckx, MSc, Project Leader, NPGP Study and CEO of the Foundation for Development of Quality Care in General Practice, Eindhoven; Hubertus JM Vrijhoef, PhD, Professor of Chronic Care, Department of Integrated Care, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht and Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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  • Hubertus JM Vrijhoef

    1. Authors:Angelique TM Dierick-van Daele, MSc, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, Maastricht; Lotte MG Steuten, PhD, Senior Researcher, Department of Health Technology and Services Research, University Twente, Enschede; Arla Romeijn, MSc, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht; Emmy WCC Derckx, MSc, Project Leader, NPGP Study and CEO of the Foundation for Development of Quality Care in General Practice, Eindhoven; Hubertus JM Vrijhoef, PhD, Professor of Chronic Care, Department of Integrated Care, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht and Scientific Centre for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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Angelique TM Dierick-van Daele, Research Fellow, Department of Integrated Care, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Telephone: 0031433874407.
E-mail: angeliquedierick@orange.nl

Abstract

Aims.  This article provides insight into the potential economic viability of nurse practitioner employment in Dutch general practices.

Background.  General practitioners face the challenging task of finding the most efficient and effective mix of professionals in general practice to accommodate future care demands within scarce health care budgets. To enable informed decision-making about skill mix issues, economic information is needed.

Design.  Discursive paper.

Method.  A descriptive and explorative design was chosen to study the economic viability of nurse practitioner employment in general practice. The conditions under which the nurse practitioner is able to earn back his/her own cost of employment were identified. Preferences and expectations of general practitioners and health insurers about nurse practitioner reimbursement were made transparent.

Results.  Although general practitioners and health insurers acknowledge the importance of the nurse practitioner in accommodating primary care demands, they have polarised views about reimbursement. The employment of nurse practitioners is seldom economically viable in current practices. It requires a reallocation of (80% of) the general practitioner’s freed up time towards practice growth (12% number of patients).

Conclusion.  The economic viability of the nurse practitioner has proven difficult to achieve in every day health care practice. This study provided insight into the complex interaction of the (cost) parameters that result in economic viability and feeds a further discussion about the content of the nurse practitioner role in general practice based on optimal quality of care vs. efficiency.

Relevance to clinical practice.  Effective and efficient health care can only be provided if the actual care needs of a population provide the basis for deciding which mix of professionals is best equipped to deal with the changing and increasing demand of care. A macro-level intervention is needed to help a broad-scale introduction of the nurse practitioner in general practice.

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