Midwives, Nurse Practitioners and Medicare: A Case Study Comparative Analysis of Medicare Reimbursement Efforts




Jessup, Debbie J.

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The historic health reform law included a provision that granted 100% Medicare reimbursement to nurse-midwives, marking the culmination of a nineteen year effort by the American College of Nurse-Midwives to achieve Medicare equity for its members. The purpose of this study was to formulate an in depth understanding of the politics, personalities and processes that defined the midwife Medicare reimbursement effort, and to explore how and why the process differed from the six year nurse practitioner Medicare reimbursement effort that culminated in 85% payment. The study used a comparative case study design to explore how the legislative efforts of midwives and nurse practitioners were impacted by special interest politics, feminist political epistemologies, and the realities of the political process and climate. Relevant data were collected from professional archival documents, congressional bill summaries, and interviews with professional organization leaders and advocates; and were organized using the strategies of case description and theoretical comparison. Analysis followed in the qualitative tradition of Yin (2009) and used pattern matching and cross case synthesis analytic techniques. The study established that Feldstein's economic version of the special interest group theory was sufficient to explain the differences in process and outcome between the NP and CNM efforts, and identified strengths and weaknesses in the two groups' political competency. Bryson's feminist political theory further clarified why these processes played out differently for two seemingly similar women's professional groups, one of whose care recipients were entirely women. The findings of this study will serve as a reference and resource for increasing the political competency of nurse practitioners and midwives.



Nursing, Public policy, Health policy, Medicare, Nurse-midwives, Nurse practitioners, Nursing reimbursment, Political competency