Physician Assistant Plans

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Aiming at overcoming workforce shortages in the health sector by new functions and educational programs, the government of Netherlands has adopted a policy to improve the functioning of the health care labour market. Issued in 2002, the policy seeks to differentiate and reallocate tasks between the medical, nursing and paramedical professions.

Purpose of health policy or idea

• The aim of this policy is to improve the working of the labour market of professions in health care, to reduces shortages of personnel and to rationalise the input of labour in health care.
• The issue in 2002 is the differentiation and reallocation of tasks between professions in healthcare and in particular the medical, nursing and paramedical professions.
• There are local initiatives for the introduction the physician assistant; in 2001 there started an initiative in Utrecht for cardiac.chirurg. PA. In 2002 followed by Arnhem/Nijmegen.

Some of the basic responsibilities that physician assistants assume in hospital practice are 24-hour first assistant coverage for the daily and emergent operating schedule; evaluating patients in the emergency department for traumatic and surgical problems; performing history and physical evaluations; conducting daily patient rounds; evaluating changes in a patient's condition; issuing orders for medications, treatments, and laboratory tests; and writing discharge summaries. Hospitals may hire PAs to function as house staff for surgical or medical departments, in emergency departments, or in intensive care units.

Main points

Main objectives

to prevent/decrease shortages by new functions and educational programs

Type of incentives

• supporting intiatives by facilitating and financial support promoting the idea

Groups affected

health care employers, medical specialists and GP?s, nursing professions, peri- and paramedical professions, patients, health-insurance companies, etc.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

Aim of the policy was to differentiate and reallocate the tasks between professions in healthcare in order to deminish the problems of shortages. The introduction of the PA is one of these initiatives.

Predicted shortages

• for nurses: 10% in 2007 ( = about 30.000)
• for GPs: 11% in 2012
• for medical specialists in 2012 : 1 to 29% dependent of particular specialty

Locals (hospitals, med. spec, nurses) took the initiative, but the government (i.c. the Ministry of Health) supports and promotes the idea's

For the qualification and education of the PA there are European rules (Bologna Agreement).

Change of government

as to the legislation and the financial consequences

Complies with

EU regulations

Bologna Agreement

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The ideas were generated by international contacts; the idea of P.A. was imported from the U.S.

As mentioned above, local hospitals, and the professional associations of medical specialists and nurses took the initiative. The government (i.c. the Ministry of Health) supports and promotes these initiatives.

Stakeholder positions

At this moment there is little opposition. Because of the prognosed shortages of GPs and medical specialists there is much appreciation.

There is however evidence that the medical specialists and GPs will give more attention to this issue when there come more initiatives and when a discussion is needed about the financing of this functions and the tariffs.

There is commitment with the idea by several hospitals.

Influences in policy making and legislation

At this moment the legislation and regulation of professions in healthcare is in a process of evaluation. The tendency is that new legislation is needed in order to regulate these new professions, the idea is that regulation must be sober.

There is an initiative of the National Board of Public Health and Health Care (a statuary advisory body towards the government) for discussion and policymaking on behalf of differentiation and reallocation of task between professions in healthcare. This not only implies the nurse practioner and the P.A., but all the professions in Dutch health care.

Adoption and implementation

Many parties will be involved in this adaptation process: the unions of medical specialists, GPs, the employers, the educational centres, the health insurance org. etc.

Financing is needed in order to cover the costs of experiments and to cover the structural costs of the education of the PA's.

The government stimulates this development with financial support and promotion.

Monitoring and evaluation

There is much consistency with the national health policy and particular the national manpower program for healthcare.

Expected outcome

The policy is expected to achieve its objectives. The effects on costs are positive: lower costs and more production. There are no contra indications for loss on quality of medical services.

The development of the function and education of the nurse practitioner is rather far. At this moment there are differences in the qualification of nurse practitioners.

Initiatives at this moment has to do with uniforming the education and qualification of nurse practitioners.

The introduction of the P.A. is yet at an early stage. Only in one big city (Utrecht) there is an education for cardiacchirurg. PA.s. A second initiative is starting elsewhere in the country (the Nijmegen/Arnhem area) to develop PA's for a broader scope of services.

There are no regulations and rules for both professions yet, however, legislation is in preparation.

In 2002 there was a growth of almost 20% in the number of students for nursing professions.

In the period of 2000-2001 there was a growth of employment in health care of 2,2% a year, the same percentage expected for 2002. In 2001 the total number of persons employed in healthcare was 859.600 (employees in nursing professions: 312.100; general practitioners: 7.932; medical specialists: 13.300).

In 2002 the universities increased the number of students admitted to start the study of medicine.

References

Author/s and/or contributors to this survey

Han van Dijk

Empfohlene Zitierweise für diesen Online-Artikel:

Han van Dijk. "Physician Assistant Plans". Health Policy Monitor, 6 May 2003. Available at http://www.hpm.org/survey/nl/b1/5