The purpose of the study is to determine the economic impact of new health practitioner (NHP) patient delegation patterns. Past studies have either (1) identified variables affecting NHP economic impact, but not controlled for or determined the effect of these variables, or (2) focussed on "task" delegation while ignoring other factors affecting NHP economic impact. This study will attempt to overcome the shortcomings of previous research. Utilization of the NHP is one factor affecting economic impact that has been frequently identified although its effect has not been determined. Patterns of delegation is a measure of NHP utilization. Three patterns of delegation will be defined and will vary on the basis of task and responsibility delegated. The extent of delegation is limited by case complexity and NHP capability, which will be measured by the consultation rate--that proportion of patients for whom the NHP requires the advice of a physician for patient management. A matched group experimental design will be used to compare the effect of three delegation patterns. Financial data, patient data, and time and motion observations will be gathered from four practice sites--three with a NHP with differing delegation patterns and a control site--for use in the application of a recursive optimization-simulation procedure. The optimization-simulation procedure involves the determination of a least-cost solution from a mathematical programming model, using data gathered from the observation sites. The least-cost solution is then simulated, using time-based measures of performances. A regression equation is derived from the simulations and incorporated as constraints in the mathematical programming model to obtain a final least-cost solution. The productivity effect and least-cost solution for each of the practices will be compared to determine the economic impact of patient delegation patterns.