ABSTRACT
This chapter aims to outline the economic issues in the area of doctor/nurse skill mix and concludes by offering a pragmatic framework that can facilitate decisions in this area. Health economics is not the only framework within which the changes can be analysed. However, unless the economic issues are thought through clearly there is a danger that resources may be utilised inefficiently. The development of skill mix is a complex area that can be approached using a number of different analytical frameworks. Although historically the development of doctor/nurse skill mix has occurred ahead of evidence of effectiveness, there is a developing literature to suggest that in some areas, substituting nurses for doctors gives equal or better health outcomes. There are a number of problems in applying economic evaluation to the development of skill mix. The chapter argues that in many cases the evidence base will not be accessible to enable an exact optimisation of skills.
