Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T15:24:40.118Z Has data issue: false hasContentIssue false

Entrepreneurial Practice for Nurses: An Assessment of the Issues

Published online by Cambridge University Press:  27 April 2021

Extract

For a number of years, some non-physician health service providers have moved to secure status as independent, autonomous providers of health services. In addition, non-physician providers have sought, often through the state legislatures, eligibility to receive payment directly, on a fee-for-service basis, from private and governmental third party payers; alternatively, they have sought for their charges to be reimbursed to their patients by insurers on such a basis. The struggle for autonomy is related to, and is preliminary to, the struggle for access to, or eligibility for, payment through third party payment mechanisms.

The purpose of this article is to explore the implications of access to such payment in the current economic climate concerning the delivery of health services. The primary focus is on the nursing profession, in light of its continuing struggle to secure greater autonomy and to improve the economic rewards for nurses. The nursing profession is waging this struggle because it recognizes that gaining direct access to third party payment would increase the potential for economic success in developing private, independent nursing practices.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1983

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See, e.g., Md. Ann. Code art. 48A §§470A (optometrists), 490 (podiatrists), 490A (psychologists) (1979); Cal. Health & Safety Code §1373, Cal. Ins. Code §10177 (West Supp. 1983) (nursing).Google Scholar
Source Book of Health Insurance Data 1981–1982 (Health Insurance Association of America, Washington, D.C.) (1982) at 7.Google Scholar
See Hershey, N., Patient Free Choice: A Relative Concept for the Insured Patient, Insurance Law Journal 553(2): 7180 (February 1969). See, e.g., Md. Ann. Code art. 48A §§470A, 490 (1979).Google Scholar
Id. §490A.Google Scholar
Clayton Act, 15 U.S.C.A. §§1-7 (1975); Sherman Antitrust Act, 15 U.S.C.A. §§12-27 (1976).Google Scholar
Goldfarb v. Virginia State Bar, 421 U.S. 773 (1975), reh'g denied, 423 U.S. 886(1976).Google Scholar
Group Health and Life Insurance Co. v. Royal Drug Co., 440 U.S. 205, reh'g denied, 441 U.S. 917 (1979).Google Scholar
Hospital Building Co. v. Trustees of Rex Hosp., 425U.S. 738(1976).Google Scholar
See Virginia Academy of Clinical Psychologists v. Blue Shield of Virginia, 624 F.2d 476 (4th Cir. 1980); Blue Shield of Virginia v. McCready, 102 S.Ct. 2540 (1982) (the right of a subscriber to sue to recover treble damages under the Clayton Act for a Blue Shield plan's alleged violation of the Sherman Act in refusing to reimburse subscriber for services rendered by a clinical psychologist, in a state that had adopted free choice legislation favorable to psychologists, necessitating that the subscriber pay the psychologists out-of-pocket expenses).Google Scholar
See, e.g., Md. Ann. Code art. 48A §354S (1983) (mandated option); Alaska Stat. §21.42.355 (Cum. Supp. 1983) (mandated benefits).Google Scholar
See Heitler, G., Mandated Benefits: Their Social, Economic, and Legal Implications, Law, Medicine & Health Care 11(6): 248 (December 1983).Google Scholar
See, e.g., Insurance Reimbursement for Licensed Certified Nurse-Midwife Services, 40 Pa. Cons. Stat. §§3001-3003 (Supp. 1982, 1983-1984).Google Scholar
Wash. Rev. Code §48.44.290 (Supp. 1983–1984) (this provision exempts HMO contracts from its application).Google Scholar
Md. Ann. Code art. 48A §354S(c) (Cum. Supp. 1981).Google Scholar
Id. §354S(a).Google Scholar
See, e.g., Haire, D., Improving the Outcome of Pregnancy through the Increased Utilization of Midwives, Journal of Nurse-Midwifery 26(1): 5–8 (January 1981); Doyle, Wildhalm, , Midwifing the Adolescents at Lincoln Hospital's Teenage Clinics, Journal of Nurse-Midwifery 24(4): 27-32 (July/August 1979); Slome, C., Effectiveness of Certified Nurse-Midwives: A Prospective Evaluation Study, American Journal of Obstetrics and Gynecology 124: 177-82 (January 15, 1983); Murdaugh, A., Experiences of a New Migrant Health Clinic, Women and Health 1 (6): 25-28 (November/December 1976); Meglen, M.C., A Prototype of Health Services for Quality of Life in a Rural County, Bulletin of Nurse-Midwifery 17(4): 103-13 (November 1972); Levy, B.S. Wilkinson, F.S. Marine, W.M., Reducing Neonatal Mortality Rate with Nurse-Midwives, American Journal of Obstetrics and Gynecology 109(1): 5158 (January 1971).Google Scholar
Slome, C., Effectiveness of Certified Nurse Midwives: A Prospective Evaluation Study, American Journal of Obstetrics and Gynecology 124(2): 177, 181, 182 (February 1976).Google ScholarPubMed
See American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, Joint Statement of Practice Relationships between Obstetricians and Certified Nurse-Midwives (November 1, 1982).Google Scholar
Ramsey, J., Physicians and Nurse Practitioners: Do They Provide Equivalent Health Care? American Journal of Public Health 72(1): 55 (January 1982); Merenstein, J. Rogers, K., Streptococcal Pharyngitis: Early Treatment and Management by Nurse Practitioners, Journal of the American Medical Association 227(11): 1278 (March 18, 1974).Google Scholar
Ramsey, supra note 20, at 56.Google Scholar
Sox, N.C., Quality of Patient Care by Nurse Practitioners and Physician's Assistants: A Ten-Year Perspective, Annals of Internal Medicine 91(3): 459, 466 (September 1979).Google ScholarPubMed
Maternity Center Association, Economic Aspects of the Child Bearing Center (Maternity Center Association, New York City) (November 30, 1982).Google Scholar
Fagin, C.M., Nursing as an Alternative to High-Cost Care, American Journal of Nursing 82(1): 56-60 (January 1982); Salkever, D.S., Episode-Based Efficiency Comparisons for Physicians and Nurse Practitioners, Medical Care 20(2): 143 (February 1982).Google Scholar
See Rosenblatt, R. Huard, B., The Nurse Practitioner as a Physician Substitute in a Remote Rural Community: A Case Study, Public Health Reports 94(6): 571 (November/December 1979) (describing financial and practical difficulties of independent, entrepreneurial practice of a rural nurse practitioner, serving as a substitute for a physician).Google Scholar