Study Finds that Managed Care Organizations Underuse Nurse Practitioners

A study released by researchers at Yale and Pace universities on the way managed care organizations MCOs employ nurse practitioners reveals a surprising inconsistency. Even though 82 percent of the MCO executives surveyed said that the use of nurse practitioners as primary care providers should be encouraged, only 44 percent actually listed them that way.

“Most of the respondents seemed to understand the strengths that nurse practitioners bring to the primary care area,” the study notes, citing in particular good communications skills, emphasis on prevention and use of behavioral approaches. Further, MCO executives reported a high degree of satisfaction with nurse practitioners as primary care providers.

So, why don’t these administrators practice what they preach? The study points to a lack of information, among both health care professionals and the public, regarding what nurse practitioners are allowed to do. Nurse practitioners have advanced education beyond the level of registered nurses, usually a master’s degree. Their practice emphasizes health promotion, disease prevention and management of common problems. Previous studies suggest that nurse practitioners can safely manage approximately 80 percent of primary care situations.

The study also found that some MCOs, especially those owned or administered by physicians, blocked the listing of nurse practitioners as primary care providers “because of the professional turf issues”; others reported that lack of consumer demand – which translates to patient confidence – held them back.

The study was conducted by Sally S. Cohen, Ph.D., R.N., F.A.A.N, assistant professor and director of the Center for Health Policy at Yale University School of Nursing; and Diana Mason, Ph.D., R.N., F.A.A.N, professor at the Lienhard School of Nursing at Pace. To obtain their results, the research team surveyed all licensed MCOs in New York and Connecticut. The results were published in the November/December 1997 issue of Nursing Economics. Cohen and Mason also studied the experiences of nurse practitioners with managed care in those two states. The findings from that study will be published this spring.

For additional information or to request a reprint of the article, contact Cohen at 203 737-2545 or send e-mail to

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