IDEAS home Printed from https://ideas.repec.org/p/fip/fedhwp/wp-2017-08.html
   My bibliography  Save this paper

Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health

Author

Listed:
  • Diane Alexander
  • Molly Schnell

Abstract

We examine whether relaxing occupational licensing to allow nurse practitioners (NPs)?registered nurses with advanced degrees?to prescribe medication without physician oversight is associated with improved population mental health. Exploiting time-series variation in independent prescriptive authority for NPs from 1990?2014, we find that broadening prescriptive authority is associated with improvements in self-reported mental health and decreases in mental-health-related mortality, including suicides. These improvements are concentrated in areas underserved by psychiatrists and among populations traditionally underserved by mental health providers. Our results demonstrate that extending prescriptive authority to NPs can help mitigate physician shortages and extend care to disadvantaged populations.

Suggested Citation

  • Diane Alexander & Molly Schnell, 2016. "Just What the Nurse Practitioner Ordered: Independent Prescriptive Authority and Population Mental Health," Working Paper Series WP-2017-8, Federal Reserve Bank of Chicago.
    • Handle: RePEc:fip:fedhwp:wp-2017-08
    as

    Download full text from publisher

    File URL: https://chicagofed.org/~/media/publications/working-papers/2017/wp2017-08-pdf.pdf
    File Function: Full text
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Stange, Kevin, 2014. "How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants," Journal of Health Economics, Elsevier, vol. 33(C), pages 1-27.
    2. Anne Case & Angus Deaton, 2017. "Mortality and Morbidity in the 21st Century," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 48(1 (Spring), pages 397-476.
    3. Morris M. Kleiner & Allison Marier & Kyoung Won Park & Coady Wing, 2016. "Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service," Journal of Law and Economics, University of Chicago Press, vol. 59(2), pages 261-291.
    4. Rockett, Ian R.H. & Samora, Julie B. & Coben, Jeffrey H., 2006. "The black-white suicide paradox: Possible effects of misclassification," Social Science & Medicine, Elsevier, vol. 63(8), pages 2165-2175, October.
    5. Molly Schnell & Janet Currie, 2018. "Addressing the Opioid Epidemic: Is There a Role for Physician Education?," American Journal of Health Economics, University of Chicago Press, vol. 4(3), pages 383-410, Summer.
    6. Angélica Meinhofer, 2018. "Prescription Drug Monitoring Programs: The Role of Asymmetric Information on Drug Availability and Abuse," American Journal of Health Economics, University of Chicago Press, vol. 4(4), pages 504-526, Fall.
    7. Currie, Janet & Stabile, Mark, 2006. "Child mental health and human capital accumulation: The case of ADHD," Journal of Health Economics, Elsevier, vol. 25(6), pages 1094-1118, November.
    8. Susan L. Ettner & Richard G. Frank & Ronald C. Kessler, 1997. "The Impact of Psychiatric Disorders on Labor Market Outcomes," NBER Working Papers 5989, National Bureau of Economic Research, Inc.
    9. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    10. Zhuan Pei & Jörn-Steffen Pischke & Hannes Schwandt, 2019. "Poorly Measured Confounders are More Useful on the Left than on the Right," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 205-216, April.
    11. Traczynski, Jeffrey & Udalova, Victoria, 2018. "Nurse practitioner independence, health care utilization, and health outcomes," Journal of Health Economics, Elsevier, vol. 58(C), pages 90-109.
    12. Morris M. Kleiner & Kyoung Won Park, 2010. "Battles Among Licensed Occupations: Analyzing Government Regulations on Labor Market Outcomes for Dentists and Hygienists," NBER Working Papers 16560, National Bureau of Economic Research, Inc.
    13. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    14. Angélica Meinhofer, 2018. "Prescription Drug Monitoring Programs: The Role of Asymmetric Information on Drug Availability and Abuse," American Journal of Health Economics, MIT Press, vol. 4(4), pages 504-526, Fall.
    15. Susan L. Ettner & Richard G. Frank & Ronald C. Kessler, 1997. "The Impact of Psychiatric Disorders on Labor Market Outcomes," ILR Review, Cornell University, ILR School, vol. 51(1), pages 64-81, October.
    16. Peter I. Buerhaus & Catherine M. DesRoches & Robert Dittus & Karen Donelan, "undated". "Practice Characteristics of Primary Care Nurse Practitioners and Physicians," Mathematica Policy Research Reports b4bd9ab6329b4044807c13f51, Mathematica Policy Research.
    17. Michael Dueker & Ada Jacox & David Kalist & Stephen Spurr, 2005. "The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis," Journal of Regulatory Economics, Springer, vol. 27(3), pages 309-330, January.
    18. Rockett, Ian R.H. & Smith, Gordon S., 1993. "Covert suicide among elderly Japanese females: Questioning unintensional drownings," Social Science & Medicine, Elsevier, vol. 36(11), pages 1467-1472, June.
    19. Anne Case & Angua Deaton, 2015. "Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century," Working Papers 15078.full.pdf, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Roy Choudhury, Agnitra & Plemmons, Alicia, 2023. "Effects of giving psychologists prescriptive authority: Evidence from a natural experiment in the United States," Health Policy, Elsevier, vol. 134(C).
    2. Petri Bockerman & Mika Haapanen & Christopher Jepsen, 2021. "Dark Passage: Mental Health Consequences of Parental Death," Working Papers 202107, Geary Institute, University College Dublin.
    3. Laura Barrie Smith, 2022. "The effect of nurse practitioner scope of practice laws on primary care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 31(1), pages 21-41, January.
    4. Anca M. Grecu & Lee C. Spector, 2019. "Nurse practitioner's independent prescriptive authority and opioids abuse," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1220-1225, October.
    5. Chen, Alice J. & Munnich, Elizabeth L. & Parente, Stephen T. & Richards, Michael R., 2023. "Provider turf wars and Medicare payment rules," Journal of Public Economics, Elsevier, vol. 218(C).
    6. RoyChoudhury, Agnitra & Petrova, Kameliia, 2023. "Impact of New York state nurse practitioners modernization act on quality of care," Economics Letters, Elsevier, vol. 230(C).
    7. Tianyuan Luo & Cesar L. Escalante & Carmina E. Taylor, 2021. "Labor market outcomes of granting full professional independence to nurse practitioners," Journal of Regulatory Economics, Springer, vol. 60(1), pages 22-54, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Simone Balestra & Helge Liebert & Nicole Maestas & Tisamarie B. Sherry, 2021. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," NBER Working Papers 29596, National Bureau of Economic Research, Inc.
    2. McMichael, Benjamin, 2017. "Beyond Physicians: The Effect of Licensing and Liability Laws on the Supply of Nurse Practitioners and Physician Assistants," Working Papers 07538, George Mason University, Mercatus Center.
    3. Daniele, Gianmarco & Le Moglie, Marco & Masera, Federico, 2023. "Pains, guns and moves: The effect of the U.S. opioid epidemic on Mexican migration," Journal of Development Economics, Elsevier, vol. 160(C).
    4. Anca M. Grecu & Lee C. Spector, 2019. "Nurse practitioner's independent prescriptive authority and opioids abuse," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1220-1225, October.
    5. Tianyuan Luo & Cesar L. Escalante & Carmina E. Taylor, 2021. "Labor market outcomes of granting full professional independence to nurse practitioners," Journal of Regulatory Economics, Springer, vol. 60(1), pages 22-54, August.
    6. Sara Markowitz & E. Kathleen Adams, 2022. "The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses," American Journal of Health Economics, University of Chicago Press, vol. 8(1), pages 65-98.
    7. Ilaria Natali & Mathias Dewatripont & Victor Ginsburgh & Michel Goldman & Patrick Legros, 2023. "Prescription opioids and economic hardship in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(9), pages 1473-1504, December.
    8. Black, Bernard & Hollingsworth, Alex & Nunes, Letícia & Simon, Kosali, 2022. "Simulated power analyses for observational studies: An application to the Affordable Care Act Medicaid expansion," Journal of Public Economics, Elsevier, vol. 213(C).
    9. Ayyagari, Padmaja & Shane, Dan M., 2015. "Does prescription drug coverage improve mental health? Evidence from Medicare Part D," Journal of Health Economics, Elsevier, vol. 41(C), pages 46-58.
    10. Markowitz, Sara & Adams, E. Kathleen & Lewitt, Mary Jane & Dunlop, Anne L., 2017. "Competitive effects of scope of practice restrictions: Public health or public harm?," Journal of Health Economics, Elsevier, vol. 55(C), pages 201-218.
    11. Grossmann, Volker & Strulik, Holger, 2021. "Illicit drugs and the decline of the middle class," Journal of Economic Behavior & Organization, Elsevier, vol. 183(C), pages 718-743.
    12. Eisenberg Daniel & Golberstein Ezra & Hunt Justin B, 2009. "Mental Health and Academic Success in College," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 9(1), pages 1-37, September.
    13. Fletcher, Jason M., 2009. "Childhood mistreatment and adolescent and young adult depression," Social Science & Medicine, Elsevier, vol. 68(5), pages 799-806, March.
    14. Xia, Xing, 2021. "Barrier to Entry or Signal of Quality? The Effects of Occupational Licensing on Minority Dental Assistants," Labour Economics, Elsevier, vol. 71(C).
    15. Stange, Kevin, 2014. "How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants," Journal of Health Economics, Elsevier, vol. 33(C), pages 1-27.
    16. Sim, Yongbo, 2023. "The effect of opioids on crime: Evidence from the introduction of OxyContin," International Review of Law and Economics, Elsevier, vol. 74(C).
    17. David Beheshti, 2019. "Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin," Health Economics, John Wiley & Sons, Ltd., vol. 28(12), pages 1449-1461, December.
    18. Carolina Arteaga Cabrales & Victoria Barone, 2021. "The Opioid Epidemic: Causes and Consequences," Working Papers tecipa-698, University of Toronto, Department of Economics.
    19. Shishir Shakya & Collin Hodges, 2023. "Must‐access prescription drug monitoring programs and retail opioid sales," Contemporary Economic Policy, Western Economic Association International, vol. 41(1), pages 146-165, January.
    20. Benjamin J. McMichael, 2017. "The Demand for Healthcare Regulation: The Effect of Political Spending on Occupational Licensing Laws," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 297-316, July.

    More about this item

    Keywords

    C-sections; Disability insurance; Medically underserved areas; Mental health; Nurse practitioner; Population;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:fip:fedhwp:wp-2017-08. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Lauren Wiese (email available below). General contact details of provider: https://edirc.repec.org/data/frbchus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.