Managed care and non-physician providers in rural areas

A study of the effect of managed care on the supply of primary care providers in rural areas was carried out using a descriptive, time-series approach. A special attention was paid to three disciplines of primary care providers: general/family practice physicians (GFs), nurse practitioners (NPs) and physician assistants (PAs). An analysis of a recent trend in GFs from 1998 Area Resource File of Bureau of Health Professions showed an increasing discrepancy in the supply of GFs between rural and urban areas. The discrepancy has worsened since managed care penetrated explosively in urban areas.; Using North Carolina's 1989--1998 NP and PA counts and its Medicaid Managed Care (MMC) Program enrollment rate, the study also examined the effect of NC MMC establishment on the supply of NPs and PAs. The growth in the supply of NPs and PAs in North Carolina's counties with Medicaid managed care established was not different from those without Medicaid managed care. However, an analysis of 1996 Medical Expenditure Panel Survey Household Component (MEPS-HC) of Agency for Health Care Policy and Research showed that more NPs and PAs were available in relation to primary care physicians in rural Medicaid managed care settings than rural non-Medicaid managed care settings. NPs and PAs in rural areas saw a higher proportion of rural MMC patients than rural Non-MMC patients. A more rigorous research design may help find the positive effect of managed care on the supply of NPs and PAs in rural areas with primary care physician shortage.