SKILL MIX CHANGES - SUBSTITUTION OR SERVICE DEVELOPMENT

An extensive review of published studies where doctors were replaced b y other health professions demonstrates considerable scope for alterat ions in skill mix. However, the studies reported are often dated and h ave design deficiencies. In health services world-wide there is a poli cy focus which emphasises the substitution of nurses in particular for doctors. However, this substitution may not be real and increased rol es for non-physician personnel may result in service development/enhan cement rather than labour substitution. Further study of skill mix cha nges and whether non-physician personnel are being used as substitutes or complements for doctors is required urgently. (C) 1998 Elsevier Sc ience Ireland Ltd. All rights reserved.