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How Does Provider Supply and Regulation Influence Health Care Market? Evidence from Nurse Practitioners and Physician Assistants

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  • Kevin M. Stange

Abstract

Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of these professions has occurred amidst considerable cross-state variation in their regulation, with some states permitting autonomous practice and others mandating extensive physician oversight. I find that expanded NP and PA supply has had minimal impact on the office-based healthcare market overall, but utilization has been modestly more responsive to supply increases in states permitting greater autonomy. Results suggest the importance of laws impacting the division of labor, not just its quantity.

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  • Kevin M. Stange, 2013. "How Does Provider Supply and Regulation Influence Health Care Market? Evidence from Nurse Practitioners and Physician Assistants," NBER Working Papers 19172, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:19172
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    Cited by:

    1. Shishir Shakya & Joshua K. Bedi & Alicia Plemmons, 2024. "Healthcare Workforce Shortages and Job Autonomy: Nurse Practitioners and Entrepreneurship in the United States," Working Papers 24-08, Department of Economics, Appalachian State University.
    2. 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.
    3. Tammy O’Rourke & Joseph Kirk & Elsie Duff & Richard Golonka, 2019. "A survey of nurse practitioner controlled drugs and substances prescribing in three Canadian provinces," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(23-24), pages 4342-4356, December.
    4. 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.
    5. 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.
    6. 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.
    7. Christina DePasquale & Kevin Stange, 2016. "Labor Supply Effects of Occupational Regulation: Evidence from the Nurse Licensure Compact," NBER Working Papers 22344, National Bureau of Economic Research, Inc.
    8. Timmons, Edward & Hockenberry, Jason & Piette Durrance, Christine, 2016. "More Battles among Licensed Occupations: Estimating the Effects of Scope of Practice and Direct Access on the Chiropractic, Physical Therapist, and Physician Labor Market," Annals of Computational Economics, George Mason University, Mercatus Center, September.
    9. Contandriopoulos, Damien & Brousselle, Astrid & Breton, Mylaine & Sangster-Gormley, Esther & Kilpatrick, Kelley & Dubois, Carl-Ardy & Brault, Isabelle & Perroux, Mélanie, 2016. "Nurse practitioners, canaries in the mine of primary care reform," Health Policy, Elsevier, vol. 120(6), pages 682-689.
    10. Timmons, Edward Joseph, 2017. "The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care," Health Policy, Elsevier, vol. 121(2), pages 189-196.
    11. 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.
    12. Jing Cai & Morris M. Kleiner, 2016. "The Labor Market Consequences of Regulating Similar Occupations: The Licensing of Occupational and Physical Therapists," Upjohn Working Papers 16-259, W.E. Upjohn Institute for Employment Research.
    13. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    14. David Balan & Patrick DeGraba & Francine Lafontaine & Patrick McAlvanah & Devesh Raval & David Schmidt, 2015. "Economics at the FTC: Fraud, Mergers and Exclusion," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 47(4), pages 371-398, December.
    15. 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.
    16. Morris M. Kleiner, 2016. "Battling over Jobs: Occupational Licensing in Health Care," American Economic Review, American Economic Association, vol. 106(5), pages 165-170, May.
    17. Alexander, Diane & Schnell, Molly, 2019. "Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health," Journal of Health Economics, Elsevier, vol. 66(C), pages 145-162.
    18. 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.
    19. Shishir Shakya & Alicia Plemmons, 2020. "Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?," Journal of Labor Research, Springer, vol. 41(4), pages 421-434, December.
    20. 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.
    21. Jing Cai & Morris M. Kleiner, 2020. "The Labor Market Consequences of Regulating Similar Occupations: the Licensing of Occupational and Physical Therapists," Journal of Labor Research, Springer, vol. 41(4), pages 352-381, December.
    22. 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.
    23. 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).
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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations

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