Among the many schemes presented to tame our rising health care costs, one plan suggests circumventing doctors when lower-cost professionals can deliver care. The proposal has emerged to address the twin needs of taming rising costs and meeting gaps in the supply of doctors. One promising approach transfers the delivery of care into the hands of nurse practitioners and community aides whenever appropriate, to reduce the burden on doctors. Research shows that nurse practitioners are as capable of providing certain types of primary care as doctors, especially for relatively routine treatments or chronic disease management.
Decreasing our reliance on M.D.’s is essential to re-balancing the economics of our health care system. Proponents of the plan would be well served, however, to emphasize the scheme’s largest benefit — substantial gains in productivity. Entrusting care delivery to lower cost medical professionals stands to relieve a significant burden on today’s informal caregivers. The movement toward providing more affordable care for routine procedures will not just save health care dollars, it will make money – boosting the overall economy. Women make up the majority of informal caregivers, and so have the most to gain from a structural change that makes routine health care for chronic illnesses more convenient and affordable. We have a remarkable opportunity to at once relieve our burdened medical and care-giving systems, while increasing the earning power of women.
Informal care-giving has wide-reaching economic implications.
Twenty percent of American adults are informal, uncompensated caregivers, providing aid to those unable to live independently. Caregivers most often care for elderly parents or relatives with chronic illnesses, like cancer and diabetes. Most Americans will be informal caregivers at some point during their lives.
This informal economy of care takes a significant toll on the formal economy. Sixty percent of informal caregivers have jobs in addition to obligations to care for another person. Additionally, a quarter of caregivers say that providing care to others keeps them from being able to work more at their paid jobs. Most caregivers report missing entire workdays as a result of their care-giving responsibilities, with seventy percent of caregivers estimating that they miss five or more days of work a year due to this second job.
Estimates show that between 60 and 75 percent of caregivers are women, and women typically spend as much as 50 percent more time providing care than male caregivers. Women also seem to find the job to be more psychologically burdensome, with many more female caregivers reporting feeling strained emotionally, physically or financially by their responsibilities. The productivity losses also vary by gender. Interestingly, studies find that men and women respond to care-giving in a fundamentally different way. Women tend to stay home during their normal working years to provide more time intensive care, while men tend to delay retirement in order to shoulder the financial burden of long-term treatments. More than half of employed female caregivers have decreased their regular working hours or pursued early retirement since taking on caretaker responsibilities. Structural reforms that would empower lower cost health care professionals offers a win-win solution to address broken elements of today’s healthcare system while moving the system toward a model that will protect the productivity of female professionals.
The movement away from M.D.’s and toward lower cost options for routine care is already gaining traction. This year, 18 states and the District of Columbia have allowed nurse practitioners to diagnose illnesses, treat patients, and even prescribe medications without a doctor’s involvement. This shift could happen more rapidly, however, if the resulting relief of the informal caregivers was a larger part of the rationale for change. The number of working women age 55 and older is projected to increase by 50 percent between 2000 and 2010, from 6.4 million to 10.1. With demographics shifting, we can’t afford to wait on a solution that simultaneously curb health care costs, while freeing up the largest growing segment of our work force.
Guest contributor Stephanie Marton is a management consultant, specializing in the health care payer industry. She recently graduated from Yale where she focused on cognitive science and economics. She holds strong interests in both medical economics and women’s health, and serves as a fellow for Arogya World, a public health non-profit organization.