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WHAT IS A PROVIDER?

What is a “provider”? It is a generic, umbrella term under which 2 main classes of players in the middle of the healthcare value chain (Figure 3-9) fall: professionals and institutions. These are defined below:

Under federal regulations, a “healthcare provider” is defined as a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice by the state and performing within the scope of their practice as defined by state law. They are collectively known as professionals.

Health care institution means an organization within the state that provides healthcare and related services, including but not limited to the provision of inpatient and outpatient care, diagnostic or therapeutic services, laboratory services, medicinal drugs, nursing care, assisted living, elderly care and housing, including retirement communities, and equipment used or useful for the provision of healthcare and related services as defined by state law. They are collectively known as professionals.

Chapter 9 analyzes perhaps the most important sector of providers: the medical profession. Following this, Chapter 10 examines nurses, pharmacists, and other paraprofessionals. The volume then turns its attention to the major institutional providers, including hospitals (Chapters 11 and 12), ambulatory care sites and pharmacies (Chapter 13), and post-acute care sites (Chapter 14).

NUMBER AND DIVERSITY OF PROVIDERS

The US healthcare system employs a lot of providers in many different settings. According to the North American Industry Classification System (NAICS) kept by the US Bureau of Labor Statistics (BLS), these settings include hospitals, ambulatory care, nursing and residential care facilities, and social assistance. The NAICS lists 99 different occupations working in these settings, accounting for more than 20.7 million workers (as of January 2020). Ten-year rates of growth in healthcare employment (over varying intervals between 1992 and 2014) have ranged anywhere from 20% to 28% (Figure 8-1).1 This made healthcare the economic sector with the fastest rate of growth in employment!

Figure 8-1

Growth in Healthcare Employment 1992 to 2018. (Source: Bureau of Labor Statistics, Employment Projections.)

This growth has been focused in health-specific occupations, not jobs found in health settings that were not health related (eg, food service, maintenance). There is heavy, but not complete, overlap between healthcare occupations and employment in healthcare settings (Figure 8-2). Over time, since the 2008-2009 recession, more of the employment in healthcare settings is accounted for by healthcare-specific occupations. The 2 largest settings accounting for the majority of healthcare employment are hospitals and the offices of healthcare practitioners such as physicians, dentists, and other ambulatory care (Figure 8-3).

Figure 8-2

Overlap Between Healthcare Occupations and Employment in Healthcare Settings (in ...

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