The influence of managed care on supply of certified nurse-midwives: an evaluation of the physician dominance thesis.
A key debate over the nature of professional power centers on the maintenance of physician dominance within the system of professions in health care. The changes in health care delivery and financing brought by managed care present a new context for evaluating the physician dominance thesis. I propose that increases in the supply of certified nurse-midwives, a "contending" health care professional group, are related to the expansion of managed care and may signal a decline in physician dominance. I analyze state-level data compiled from governmental, health professional, and industry sources to determine the influence of managed care market penetration, physician supply, state policy context, and demographic factors on the state-level supply of nurse-midwives. Results indicate that, despite high physician supply, nurse-midwife supply is higher in states with higher managed care penetration, as well as in those with more favorable state policy environments and a more educated demographic base. Outcomes from a series of hypothesis tests support my assertion that the expansion of managed care is altering the jurisdictional boundaries in the system of professions in health care, eroding the dominance of physicians while creating new openings for nurse-midwives.
Hartley
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Department of Sociology, University of Wisconsin-Madison 53706, USA. hartley@ssc.wisc.edu
D006291:Health Policy; D006801:Humans; D008329:Managed Care Programs / Q000191:economics; D009721:Nurse Midwives / Q000600:supply & distribution*; D010820:Physicians / Q000523:psychology* / Q000600:supply & distribution; D011209:Power, Psychological; D012044:Regression Analysis; D014481:United States; D000078329:Workforce