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Competitive Effects of Scope of Practice Restrictions: Public Health or Public Harm?

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  • Sara Markowitz
  • E. Kathleen Adams
  • Mary Jane Lewitt, PhD, CNM
  • Anne Dunlop, MD

Abstract

The demand for health care and healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate health care workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice. In this paper, we examine the controversy surrounding SOP restrictions for certified nurse midwives (CNMs). We use the variation in SOP laws governing CNM practice that has occurred over time in a quasi-experimental design to evaluate the effect of the laws on the markets for CNMs and their services, and on related maternal and infant outcomes. We focus on SOP laws that pertain to physician oversight requirements and prescribing rules, and examine the effects of SOP laws in geographic areas designated as medically underserved. Our findings indicate that SOP laws are neither helpful nor harmful in regards to maternal behaviors and infant health outcomes, but states that allow CNMs to practice with no SOP-based barriers to care have lower rates of induced labor and Cesarean section births. We discuss the implications of these findings for the policy debate surrounding SOP restrictions and for health care costs.

Suggested Citation

  • 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.
    • Handle: RePEc:nbr:nberwo:22780
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    Cited by:

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    2. Apergis, Nicholas & Chasiotis, Ioannis & Georgantopoulos, Andreas G. & Konstantios, Dimitrios, 2021. "The integration of share repurchases into investment decision-making: Evidence from Japan," International Review of Financial Analysis, Elsevier, vol. 78(C).
    3. Noghanibehambari, Hamid & Fletcher, Jason, 2023. "Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws," Journal of Health Economics, Elsevier, vol. 92(C).
    4. Jie Chen & Chad D. Meyerhoefer & Edward J. Timmons, 2024. "The effects of dental hygienist autonomy on dental care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1726-1747, August.
    5. Dick M. Carpenter & Lisa Knepper & Kyle Sweetland & Jennifer McDonald, 2018. "The Continuing Burden of Occupational Licensing in the United States," Economic Affairs, Wiley Blackwell, vol. 38(3), pages 380-405, October.
    6. Guo, Jiapei & Kilby, Angela E. & Marks, Mindy S., 2024. "The impact of scope-of-practice restrictions on access to medical care," Journal of Health Economics, Elsevier, vol. 94(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.
    8. 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).
    9. 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.
    10. 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.
    11. Pinka Chatterji & Chun-Yu Ho & Xue Wu, 2023. "Obstetric Unit Closures and Racial/Ethnic Disparity in Health," NBER Working Papers 30986, National Bureau of Economic Research, Inc.
    12. 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).
    13. Ioannis Chasiotis & Andreas G. Georgantopoulos, 2021. "The flexibility of corporate payouts vis-à-vis capital investment: some UK evidence," International Journal of Managerial Finance, Emerald Group Publishing Limited, vol. 18(1), pages 181-201, February.
    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. Hoehn-Velasco, Lauren & Jolles, Diana R. & Plemmons, Alicia & Silverio-Murillo, Adan, 2023. "Health outcomes and provider choice under full practice authority for certified nurse-midwives," Journal of Health Economics, Elsevier, vol. 92(C).

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations
    • K2 - Law and Economics - - Regulation and Business Law

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