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Health Policy. 2015 Sep;119(9):1176-87. doi: 10.1016/j.healthpol.2015.04.001. Epub 2015 Apr 13.

Costs and effects of new professional roles: Evidence from a literature review.

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Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK. Electronic address:
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland, UK.
Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany.


One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs. A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985-2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies. Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8). Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.


Costs; Effects; Health service redesign; Impact; New professional roles; Skill-mix

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