New study finds relationship between socioeconomic factors and distribution of anesthesia providers

American Association of Nurse AnesthetistsDec 10 2015

A new study suggests that Certified Registered Nurse Anesthetists (CRNAs) are the main anesthesia professionals ensuring patient access to critical anesthesia care in lower-income areas where the populations are more likely to be uninsured, unemployed and/or Medicaid eligible.

The study, titled "Geographical Imbalance of Anesthesia Providers and its Impact on the Uninsured and Vulnerable Populations," which was recently published in Nursing Economic$, was conducted to determine if there is a relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia providers - specifically CRNAs or physician anesthesiologists.

Using data from the 2012 U.S. Health Resources and Services Administration Area Resource File (ARF), the study found that there are more CRNAs in counties with lower-income populations, thus ensuring these vulnerable patient populations access to anesthesia required for surgery, labor and delivery, trauma care, and chronic pain management. Anesthesiologists are more closely aligned with counties that have higher-income populations. CRNAs are also more likely found in states with less-restrictive practice regulations where more rural counties are present.

"These findings point to the significance CRNAs have in providing access to anesthesia care to low-income and vulnerable populations," said lead researcher Lorraine M. Jordan, PhD, CRNA, FAAN, Senior Director of Research for the American Association of Nurse Anesthetists (AANA). "As the Affordable Care Act (ACA) places increased demands on the healthcare system due to the newly insured or Medicaid-eligible, including demands for surgical and pain management services, the role of CRNAs will become even more critical in providing access to quality healthcare to these populations."

CRNAs are already the primary providers of anesthesia services in rural America, and in some states, are the sole anesthesia professionals in nearly 100 percent of rural hospitals. "States need to remove barriers to scope of practice for CRNAs in order to respond to the influx of millions of newly insured and Medicaid participants and assure these vulnerable populations have access to anesthesia services without overburdening the healthcare system," said Juan Quintana, CRNA, DNP, MHS, president of AANA.

According to a 2014 census data report, 15.8 million people have already gained coverage since the ACA marketplaces opened in late 2013. In addition, according to an Urban Institute analysis, approximately 22.3 million uninsured adults are expected to become eligible for Medicaid under the ACA.

CRNAs practice in all 50 states, safely providing approximately 40 million anesthetics to patients each year. Additional research, such as the 2010 RTI study that appeared in Health Affairs, verifies the quality and safety of nurse anesthesia care. The RTI study examined nearly 500,000 individual cases and confirmed what previous studies had shown: CRNAs provide safe, high-quality care regardless of whether they are working independently or under physician supervision. According to another landmark study published in 2010, CRNAs are also the most cost-effective anesthesia providers in all settings where anesthesia is delivered.