Evidence Brief- Cost of CareNurse Practitioners
  • In a review of studies comparing the cost of primary care when delivered by NPs and physician assistants (PAs) to care provided by MDs, researchers found that, in studies where NPs and PAs assumed care roles previously occupied by MDs, “substitution of visits to physicians by visits to NPs and PAs achieved savings in the first year of implementation” (Naylor and Kurtzman 2010).
  • A study of 26 capitated care practices of a group model managed care organization found that total labor costs were lowest in practices where NPs and PAs were used to a greater extent (Roblin et al., 2005).
  • A study comparing NP versus MD management of post-revascularization hypercholesterolemia found that patients managed by NPs are more likely to comply with the prescription regimen and achieve their health goals at a lower cost (Paez and Allen, 2006).
  • Using Massachusetts-specific MEPS data, a recent RAND study estimated NP and PA visits are 35 percent less expensive than physician visits. They estimate that if scope of practice laws were expanded and the number of NPs and PAs visits increased, Massachusetts could save between $4.2 and $8.4 billion over the course of the next ten years (Eibner et al., 2009).
  • In a cross-sectional comparison of retail clinics (staffed almost exclusively by NPs and PAs), researchers found that the cost of care provided in retail clinics is far lower than care provided in primary care physician practices and emergency departments, while quality remained constant (Mehrotra et al., 2008).
  • In an analysis of an on-site NP program launched by a U.S. metal and plastic manufacturing firm covering 4,284 employees and their dependents, researchers observed substantial reductions in annual health care costs ($1.3 million) as a result of the investment ($83 thousand), yielding a cost-benefit ratio of 1:15 (Chenoweth et al., 2005).
Certified Nurse Midwives (CNMs)
  • A random sampling of providers delivering pre and perinatal care to low-risk women in Washington State found that certified nurse midwives used 12.2% fewer resources than obstetricians, with comparable outcomes in terms of number of live births and birth weight. Researchers attributed the lower resource use to reduced rates of Caesarean sections, labor induction, and epidural anesthesia (Rosenblatt et al., 1997).
Chenoweth, D., Martin, N., Pankowski, J., et al. “A Benefit-Cost Analysis of a Worksite Nurse Practitioner Program: First Impressions,” Journal of Occupational and Environmental Medicine, November 2005, Vol. 47, No. 11, pp. 1110-116.
Eibner, C.E., Hussey, P.S., Ridgely, M.S., et al. “Controlling Health Care Spending in Massachusetts: An Analysis of Options,” RAND Corporation, August 2009. Available at: www.rand.org/pubs/technical_reports/TR733.html (last accessed January 11, 2011).
Mehrotra, A., Wang, M.C., Lave, J.R., et al. “Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison of Patients’ Visits,” Health Affairs, September/October 2008, Vol. 27, No. 5, pp. 1272-282.
Naylor, M.D., Brooten, D., Campbell, R., et al. “Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders,” Journal of the American Medical Association, February 17, 1999, Vol. 281, No. 7, pp. 613-20.
Naylor, M.D. and Kurtzman, E.T. “The Role of Nurse Practitioners in Reinventing Primary Care,” Health Affairs, May 2010, Vol. 29, No. 5, pp. 893-99.
Paez, K.A. and Allen, J.K. “Cost-Effectiveness of Nurse Practitioner Management of Hypercholesterolemia Following Coronary Revascularization,” Journal of the American Academy of Nurse Practitioners, September 2006, Vol. 18, No. 9, pp. 436-44.
Roblin, D.W., Howard, D.H., Becker, E.R., et al. “Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO,” Health Services Research, June 2004, Vol. 39, Issue 3, pp. 607-25.
Rosenblatt, R.A., Dobie, S.A., Hart, L.G., et al. “Interspecialty Differences in the Obstetric Care of Low-Risk Women,” American Journal of Public Health, March 1997, Vol. 87, No. 3, pp. 344-51.
Author Information: 


This evidence brief was produced by the Robert Wood Johnson Foundation Nursing Research Network to provide a summary of the evidence on key issues related to nursing policy and practice.  For further information, please contact Lori Melichar at the Robert Wood Johnson Foundation lmelichar@rwjf.org