The macroeconomic benefits of Tennessee APRNs having full practice authority.

BACKGROUND: To-date, advocacy efforts to advance full practice authority for APRNs have primarily stressed arguments based on evidence on the cost effectiveness and quality of APRN-provided care, as well as the improved care access and patient satisfaction these providers offer. PURPOSE: The economic impact analysis forecasts the additional job and economic output associated with granting Tennessee APRNs full practice authority. METHODS: The IMPLAN software and a variety of data inputs were used to estimate the direct, indirect, and induced economic impact on jobs, labor income, value-added benefits, total output, and tax revenues. FINDINGS: From a 2017 baseline, the cumulative impact of granting Tennessee APRNs full practice authority is a net gain of 25,536 jobs and $3.2 billion in economic impact. DISCUSSION: Granting Tennessee APRNs full practice authority would confer substantial economic benefits and employment opportunities to the state.

Choosing a medical specialty: the difference between what students want and what society needs.

The choice of a specialty by medical students is a complex one that has significant implications for the future supply of physician manpower. The study by Weissman et al. portrays this choice as reflecting the degree of congruence between a student's needs and values and his or her perception of the characteristics of the various specialties. The existing shortages in the supply of various specialists in Israel may be interpreted as signifying a lack of alignment of student needs and perceptions. This commentary will extend the implications of this work to include the connection between students' choices and the physician manpower needs of society, and will focus on primary care physician shortages in the United States as but one example of the implications of these relationships.

Impact of high-deductible health plans on health care utilization and costs.

BACKGROUND: High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. OBJECTIVE: To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. DATA: Claims and member data from a major insurer and zip code-level census data. STUDY DESIGN: Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). RESULTS: In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. CONCLUSIONS: Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives.

The three Tennessees: child and infant health in the three Grand Divisions of Tennessee.

Tennessee consistently ranks low among all states in measures of health. This study was undertaken to examine the differences in child and infant health conditions in the state's three Grand Divisions and the impact of these differences on Tennessee's overall rankings. An analysis of county-level data selected from the Area Resources File demonstrated that, for most measures of infant health and child health, the three divisions ranked very differently and that the overall state ranking did not accurately reflect the conditions in the divisions. Some regions, most often Middle Tennessee, ranked much higher than did the state as a whole; other regions, most often West Tennessee, ranked lower. The single overall state ranking masked these regional differences while suggesting that the entire state had equally low health outcomes. The striking health variations among the divisions that were demonstrated highlight the need to examine health conditions and implement health improvement efforts on a regional rather than a statewide basis.