Improving Efficiency in the Health-Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants

In an era characterized by high levels of U.S. health-care spending and inadequate health outcomes, it is vital for policymakers to explore opportunities for enhancing productivity. Important productivity gains could be achieved by altering the mix of labor inputs used in the health-care sector. However, the potential for these gains is sharply limited by anticompetitive policy barriers in the form of restrictive scope of practice (SOP) laws imposed on physician assistants and advanced practice registered nurses. In this proposal we discuss evidence that shows how these laws restrict competition, generate administrative burdens, and contribute to increased health-care costs, all while having no discernable health benefits. We discuss how moving to a fully authorized SOP for these providers can free up labor markets, allowing for a more-cost-effective and more-productive use of practitioners, while potentially fostering innovation and still protecting public health. A key outcome would be improved access to care as gains in productivity increases capacity in the health-care system. We conclude with a discussion of state and federal policies that either remove these barriers directly or encourage state legislative bodies to do so.

E. Kathleen Adams and Sara Markowitz

The Hamilton Project

June 2018

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