IDEAS home Printed from
   My bibliography  Save this paper

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


  • Kevin M. Stange


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.

Suggested Citation

  • 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
    Note: HC HE LS

    Download full text from publisher

    File URL:
    Download Restriction: no

    Other versions of this item:

    References listed on IDEAS

    1. Gary S. Becker & Kevin M. Murphy, 1994. "The Division of Labor, Coordination Costs, and Knowledge," NBER Chapters,in: Human Capital: A Theoretical and Empirical Analysis with Special Reference to Education (3rd Edition), pages 299-322 National Bureau of Economic Research, Inc.
    2. Giovanni Peri & Chad Sparber, 2016. "Task Specialization, Immigration, and Wages," World Scientific Book Chapters,in: The Economics of International Migration, chapter 3, pages 81-115 World Scientific Publishing Co. Pte. Ltd..
    3. Karen Donelan & Catherine M. DesRoches & Robert S. Dittus & Peter Buerhaus, 2013. "Perspectives of Physicians and Nurse Practitioners on Primary Care Practice," Mathematica Policy Research Reports b66c95bc1f9d4d5483168c4be, Mathematica Policy Research.
    4. A. Frank Adams III & Robert B. Ekelund Jr. & John D. Jackson, 2003. "Occupational Licensing of a Credence Good: The Regulation of Midwifery," Southern Economic Journal, Southern Economic Association, vol. 69(3), pages 659-675, January.
    5. V. Joseph Hotz & Mo Xiao, 2011. "The Impact of Regulations on the Supply and Quality of Care in Child Care Markets," American Economic Review, American Economic Association, vol. 101(5), pages 1775-1805, August.
    6. Craig L. Garthwaite, 2012. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 190-215, August.
    7. 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.
    8. Catherine Schaumans & Frank Verboven, 2008. "Entry and regulation: evidence from health care professions," RAND Journal of Economics, RAND Corporation, vol. 39(4), pages 949-972.
    9. Leland, Hayne E, 1979. "Quacks, Lemons, and Licensing: A Theory of Minimum Quality Standards," Journal of Political Economy, University of Chicago Press, vol. 87(6), pages 1328-1346, December.
    10. Avner Shared & John Sutton, 1981. "The Self-Regulating Profession," Review of Economic Studies, Oxford University Press, vol. 48(2), pages 217-234.
    11. 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.
    12. William D. White, 1978. "The Impact of Occupational Licensure of Clinical Laboratory Personnel," Journal of Human Resources, University of Wisconsin Press, vol. 13(1), pages 91-102.
    13. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics, Palgrave Macmillan.
    14. Carl Shapiro, 1986. "Investment, Moral Hazard, and Occupational Licensing," Review of Economic Studies, Oxford University Press, vol. 53(5), pages 843-862.
    15. Katherine Baicker & Amitabh Chandra, 2004. "The Productivity of Physician Specialization: Evidence from the Medicare Program," American Economic Review, American Economic Association, vol. 94(2), pages 357-361, May.
    16. Morris M. Kleiner, 2000. "Occupational Licensing," Journal of Economic Perspectives, American Economic Association, vol. 14(4), pages 189-202, Fall.
    17. Kleiner, Morris M & Kudrle, Robert T, 2000. "Does Regulation Affect Economic Outcomes? The Case of Dentistry," Journal of Law and Economics, University of Chicago Press, vol. 43(2), pages 547-582, October.
    18. Mark V. Pauly & Mark A. Satterthwaite, 1981. "The Pricing of Primary Care Physicians' Services: A Test of the Role of Consumer Information," Bell Journal of Economics, The RAND Corporation, vol. 12(2), pages 488-506, Autumn.
    19. 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.
    20. David E. Kalist & Stephen J. Spurr, 2004. "The Effect of State Laws on the Supply of Advanced Practice Nurses," International Journal of Health Economics and Management, Springer, vol. 4(4), pages 271-281, December.
    21. repec:mpr:mprres:7786 is not listed on IDEAS
    22. Sass, Tim R & Nichols, Mark W, 1996. "Scope-of-Practice Regulation: Physician Control and the Wages of Non-Physician Health-Care Professionals," Journal of Regulatory Economics, Springer, vol. 9(1), pages 61-81, January.
    Full references (including those not matched with items on IDEAS)


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

    Cited by:

    1. Christina DePasquale and Kevin Stange, 2014. "Labor Supply Effects of Occupational Regulation: Evidence from the Nurse Licensure Compact," Emory Economics 1414, Department of Economics, Emory University (Atlanta).
    2. Sara Markowitz & E. Kathleen Adams & Mary Jane Lewitt, PhD, CNM & Anne Dunlop, MD, 2016. "Competitive Effects of Scope of Practice Restrictions: Public Health or Public Harm?," NBER Working Papers 22780, National Bureau of Economic Research, Inc.
    3. 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.
    4. 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.
    5. Jing Cai & Morris M. Kleiner, 2016. "The Labor Market Consequences of Regulating Similar Occupations: The Licensing of Occupational and Physical Therapists," Upjohn Working Papers and Journal Articles 16-259, W.E. Upjohn Institute for Employment Research.
    6. 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.
    7. 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.
    8. Alexander, Diane & Schnell, Molly, 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.
    9. repec:eee:jhecon:v:55:y:2017:i:c:p:201-218 is not listed on IDEAS

    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

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    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:nbr:nberwo:19172. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (). General contact details of provider: .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.