Public Policy Government Intervention: Is It Necessary for Nursing?
S THERE AN argument for public policy related to nursing? As I begin my 2-year commitment as your assistant editor for Public Policy, I have chosen to review the framework I use to judge whether government intervention is necessary, given the situation. (Public policy is the intervention of government when free enterprise does not accomplish society's objectives.) A set of criteria for judging the need for governmental involvement removes the argument from the self-serving realm and helps assign responsibility to the appropriate party. I invite nursing, which has long relied on government intervention to accomplish many of its goals in education and service, to review these criteria with me. In an era characterized by the rhetoric of less government, whether realized or not, this review is especially timely. My guidelines suggest that government has a legitimate role if any one of the following conditions exists.
Inadequate i~rvmtion. Does the public have information about the essential role of nursing in health care? Is the nurse perceived as an expert decision maker essential for health care or as a helper?
Limited competition. Does the public have more than one nurse trying to attract the consumer to receive services from the nurse? Can the public choose from which nurse to receive care? CONNIE FLYNT MULLINIX, M B A , M P H , R N
Clinical Assistant Professor School of Nursing Uniz'ersity of North Carolina at ChapelHill Chapel Hill, NC 27599-7460 © 1990 by \V.B. Saunders Company. 8755-7223/90/0601-000453.00/0
Slow adjustment. When the demand for nursing services or nursing education changes, are nursing organizations immediately able to change their output? Is there a lag time between recognizing the need for a nurse and producing that nurse?
Excessi~,e cost of transaction. Are nurses located geographically and organizationally so consumers can obtain care without excess cost? Is the cost of nurse education prohibitive? Readers probably recognize the adverse of these four conditions as prerequisites for a market to work.* Two additional conditions also argue for government intervention:
Externalities or third-party effects. Does nursing contribute to the good of society? Do the services provided to one individual benefit others?
Market outcomes that society rejects. Has nursing produced practitioners able to care for increasing numbers of elderly or chronically ill persons? From these questions, it will be obvious to many readers that government does have a role with nursing. During the next 2 years, I plan t o explore systematically the areas in which government is involved with nursing and areas in which government might be involved. Additionally, I will explore public policy's impact on the broader health care system. Finally, I hope to mention the stimuli for public policy interventions that currently exist in the private sector. I welcome your comments. Reference 1. Mansfield E: Microeconomics Theory and Applications (ed 4). New York, NY, Norton, 1982
Journal of Professional Nursing, Vol 6, N o 1 ( J a n u a r y - F e b r u a r y ) , 1990: p 5