In this posting, authors address the topic "Who Pays Whom for What in Health Care?" It is a topic now at the forefront in health care. It is a topic on the minds not just of the providers and payers but also the consumer. Systems of coverage and payment are rapidly changing and everyone is directly affected by these changes. Are the changes more cost effective or has there simply been a shift in who the recipients of revenue are? Are outcomes more appropriate, adequate, efficient and/or effective? The articles in this posting examine many factors of this complex issue.
In the first article, Sochalski and Patrician examine spending patterns in the United States tracing trends of the past half century. Figures show health care spending relative to the nation's overall spending pattern. Quite informatively, the authors relate health care spending trends and nursing service and suggest opportunities for nursing to identify its cost and value.
Harris then advances the notion that if advanced practice nurses are to successfully compete in the market place with an over supply of physicians, competitive pricing will be a necessary factor. That cost effectiveness and quality are not incompatible is a conclusion that definitely needs to be examined.
Lastly, the article by Carolyn Melby takes a distinctly different position from that of Harris suggesting that advanced practice nurses need to be reimbursed for the "full value" of their services. Her premise is that the product, not the provider, should constitute the base for establishing the unit price.
Stimulating, provocative and thoughtful input should occur by you, the reader, as you examine the various issues, arguments, and viewpoints here provided. We invite you to respond. The topic is one in which there is yet a window of opportunity to affect change in policy and outcomes. May this be a forum for creative thought and dialogue.
Published June 10, 1998
