This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and (3) the effects of changing the payment method on the health care costs of patients, third-party payers, and society. Chapter 1 summarizes the case study and defines and describes NPs, PAs, and CNMs. Chapter 2 reviews studies comparing the care provided by these practitioners with that provided by physicians as well as studies that gauge patients' satisfaction with physicians' acceptance of the care provided by these three groups. Chapter 3 considers access to health care; and chapter 4 focuses on productivity, costs, and employment. Chapter 5 analyzes the implications of various payment modifications for the employment and practice of NPs, PAs, and CNMs and for health care costs; examines the effects new developments could have on the three groups; and assesses how payment modifications might influence the roles of these practitioners and the costs of health care. Appendixes describe the methodology of the study, provide a detailed description of payment for services by third-party payers in the public and private sectors, and list 268 references. (KC)