The contribution of mid-level practitioners such as nurse practitioners and physician assistants practicing in the public sector to increasing access to health care for inner-city communities is well documented. However, relatively little is known about the contribution of mid-level practitioners in the private sector. Using the 1996 American Medical Association's Medical Group Survey data, this study examines the relationship between the number of mid-level practitioners in a medical group and the percentage of the corresponding medical group's patients who have Medicaid. Negative binomial regression was used because our dependent variable is a count variable and there was a serious overdispersion problem. The results showed that the variable "Medicaid patient percent" was significant in explaining the number of mid-level practitioners, controlling for the number of physicians. For each 10% increase in Medicaid patients, there was 6.6% increase in the number of mid-level practitioners. This positive relationship was also found in New York and Los Angeles regions. However, no relationship was found for Chicago. This exception may be explained by two facts about Illinois. Illinois was one of the last two states that joined the nation in allowing nurse practitioners and physician assistants some prescription rights. Furthermore, Illinois was one of the states with low supply of nurse practitioners (ranked 47 th in 1998) and physician assistants (43 th). Therefore, policies of increasing the overall supply of mid-level practitioners and improving their practice environments may boost the availability of mid-level practitioners in impoverished areas.
Learning Objectives: 1. Estimate the contribution of nurse practitioners and physician assistants in medical group practices to increasing access to health care in impoverished areas. 2. Identify the states that showed relative success in increasing the availability of nurse practitioners and physician assistants in impoverished areas.
Keywords: Urban Health Care, Access to Health Care
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