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9 Yale J. on Reg. 417 (1992)
Health Care Dollars and Regulatory Sense: The Role of Advanced Practice Nursing

handle is hein.journals/yjor9 and id is 423 raw text is: Health Care Dollars and Regulatory Sense: The Role of Advanced Practice Nursing Barbara J. Safriett Our current health care system has been criticized for providing too little care, too late, for too few people, at too high a cost. In this Article, Dean Safriet argues that these problems require a fundamental restructuring of existing health care delivery systems and more effective utilization of all health care personnel. Dean Safriet urges immediate legislative reform to reduce the restrictions that currently constrain advanced practice nurses, especially nurse practitioners and certified nurse-midwives. Advanced practice nurses have demonstrated repeatedly that they can provide cost-effective, high-quality primary care for many of the neediest members of society, but their role in providing care has been has been severely limited by restrictions on their scope of practice, prescriptive authority, and eligibility for reimbursement. Eliminat- ing these restriction would enable advanced practice nurses to increase access to health care while preserving quality and reducing costs. Introduction ......................................... 419 1. Nurse Practitioners and Certified Nurse-Midwives: Advanced Practice Nurses in Primary Care ............................... 422 A. Defining Primary Care ............................ 422 B. Defining the Role of Nurse Practitioners ................ 423 C. Defining the Role of Certified Nurse-Midwives ............ 425 II. The Effectiveness of Nurse Practitioners and Certified Nurse-Midwives ............................. 426 A. Quality of Care .................................. 427 1. Nurse Practitioners .............................. 427 2. Certified Nurse-Midwives ........................ 429 B. Access Implications ............................... 431 C. Cost-Effectiveness Implications ........................ 434 tAssociate'Dean and Lecturer of Law, Yale Law School. B.A. Goucher College, 1969; J.D., University of Maryland, 1975; LL.M., Yale Law School, 1982. I enthusiastically acknowledge both the wise counsel and the unfailing support of my colleague Judith L. Miller, as well as the good-natured and detailed contributions of Christopher Austin and Judy Couture in the preparation of this article. I have also benefitted greatly from the comments of Ira Gunn, Jay Katz, and Diana Taylor, whose commitment and professionalism exemplify the highest standards of the health care professions. Copyright © 1992 by the Yale Journal on Regulation 417

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