Direct reimbursement by insurers for the services of nurses and nurse practitioners is a primary goal of many state and national associations of nurses. Direct reimbursement means either that a nurse is paid directly by the insurer for nursing or nurse practitioner services rendered, or that the patient is reimbursed for costs incurred for those services. The issue is important to nurses for several reasons.

First, reimbursement allows rhe consumer of health care a wider choice of types of providers from whom to purchase care. As a practical matter, if an insurer does not reimburse for the care rendered by one type of professional, patients are likely to seek care from another whose services are paid by health insurance. The General Accounting office, for example, has lited restrictive third party reimbursement practices as one of the obstacles impeding the wider use of nurse-midwives. Second, some types of health care are less expensive when rendered by a nurse or a nurse practitioner; reimbursement thus can provide quality care at a lower cost. Third, reimbursement is a form of recognition that practice styles are changing. In 1983, West Virginia became the first state that explicitly reimburses for care provided by “nonsalaried duly licensed registered professional nurses engaged in private nursing practice or partnership.”