reference library

Is government guiding the invisible hand at the top of the labor market? We study this question among physicians, the most common occupation among the top one percent of income…
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People living in rural areas have worse health outcomes than their urban counterparts do. Understanding what factors account for this could inform policy interventions for reducing rural-urban disparities in health….
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The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health…
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Why are prices in some sectors increasing dramatically even as economy-wide technology and productivity improves? Education and healthcare are notable examples of sectors seemingly stricken by constantly rising prices. Educational…
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Occupational licensing laws have been relaxed in a large number of U.S. states to give nurse practitioners the ability to perform more tasks without the supervision of medical doctors. We…
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All PAs must practice with a collaborating physician; however, state laws dictate the extent of that relationship. This interactive guide provides an overview of PA scope of practice laws by…
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In 2005 the United States spent $6,401 per capita on health care-more than double the per capita spending in the median Organization for Economic Cooperation and Development (OECD) country. Between…
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The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting…
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” Pew Health Professions Commission endorses the need to reform the regulatory system, the general vision articulated by the Taskforce on the future of the system, and the invitation to…
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“The Federation of State Medical Boards (the Federation) is a national non-profit association whose membership includes all medical licensing and disciplinary boards in the United States, and the U.S. territories….
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This brief describes a range of state-based regulations or policies that either limit or prohibit dental hygienists from sealing children’s teeth at school, or create financial burdens that work against…
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The role of licensing in driving up healthcare costs has been almost completely ignored. The apparent explanation is that nobody can imagine that there is any alternative. The obvious complexity…
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The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence…
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A growing body of evidence shows that areas with robust primary care systems tend to have better outcomes and lower per capita costs than areas that rely more on specialists….
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An effective health care system needs to coordinate medical facilities with the behavioral and economic drivers in communities that are most related to good long-term health. Intermediaries can help this…
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There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related…
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Pharmacists have been prescribing in the UK since 2003, following the success of nurse prescribing. The review of prescribing, supply and administration of medicines (the second Crown Report) in 1999…
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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…
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This paper examines the impact of California’s hospital closures occurring from 1995-2011 on adjusted inpatient mortality for time-sensitive conditions: sepsis, stroke, asthma/chronic obstructive pulmonary disease (COPD) and acute myocardial infarction…
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This study provides a comprehensive assessment of access to mental health and substance use disorder (SUD) treatment in Michigan. It identifies current challenges and provides a baseline against which progress…
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BPOA worked in coordination with Saint Francis University’s Knee Center for the Study of Occupational Regulation (CSOR) to compile data on regional equivalent professional and occupational licensure. The report found…
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Many opioid control policies target the prescribing behavior of health care providers. In this paper, we study the first comprehensive state-level policy requiring providers to access patients’ opioid history before…
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Beneficiaries attributed to PCNPs had lower hospital admissions, readmissions, inappropriate emergency department use, and low-value imaging for low back pain. Beneficiaries attributed to PCMDs were more likely than those attributed…
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PURPOSE Evidence that fewer children are being seen at family physician (FP) practices has not been confirmed using population-level data. This study examines the proportion of children seen at FP…
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In this policy brief, we use a novel dataset generated using OL RegData to explore differences in the stringency of occupational licensing for select states in the Midwest and mid-Atlantic…
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Whatever one’s opinion of the federal and state government response to the COVID-19 pandemic, the virus and associated “shelter at home” orders clearly had a devastating impact on the U.S….
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This report concludes that DEA and SAMHSA have the legal authority to extend the flexibilities granted during the COVID-19 public health emergency without additional authorization from Congress. DEA and SAMHSA…
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Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may…
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There is a need in the United States for greater access to dental and oral health services. As of 2018, over five thousand three hundred dental Health Professional Shortage Areas…
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Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the…
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The American Association of Nurse Practitioners® (AANP) released both the new national nurse practitioner (NP) count and findings from its 2018 National Nurse Practitioner Sample Survey. As of January, a…
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Nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs) represent a growing part of the nation’s primary care workforce. These Advanced Practice Clinicians help expand primary care capacity…
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The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice. An online survey of Australian…
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Wide variation exists between the nursing competence requirements seen in the emergency care context and the subsequent design of nursing education programmes. Clarifying nursing roles and scope of prac- tice…
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Telecontraception is the provision of contraception prescriptions online as an alternative to traditional clinic visits. In this study, standardized patients were asked to represent a range of relative and absolute…
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For decades, U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations vary from state-to-state…
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Our aim in conducting the State Medical Boards Awareness Study was to measure national awareness of state medical boards, as well as gain insights on Americans’ experiences with, and responses…
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The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence…
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Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full…
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The U.S. healthcare system is facing workforce shortages in rural and primary care settings. Despite growing demand for providers and comparable quality metrics, advanced practice registered nurses (APRNs) still face…
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Debates over economic policy are often framed as conservatives supporting market-oriented policies, while progressives support government interventions. However, there are many market-oriented policies that can lead to more equality, an…
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Family physicians’ scope of practice is declining despite being well prepared to provide a range of clinical services. To evaluate whether this is a new phenomenon, we compared the proportions…
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Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have…
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Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine…
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For the past few decades, the United States has not produced enough primary care physicians. Moreover, too few physicians practice in rural and medically underserved areas, and the number of…
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“This project explored the effects of nurse practitioner (NP) scope of practice (SOP) legislation on the distribution and practice patterns of NPs as well as their billing practices. The goal…
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Many states allow nurse practitioners (NPs) to practice and prescribe drugs without physician oversight, increasing the number of autonomous primary care providers. We estimate the causal impact of NP independence…
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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…
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It is widely recognized that there is significant state-level variation in scope-of-practice regulations (SSoPRs) for nurse practitioners (NPs). This study was designed to examine whether SSoPRs influence labor markets for…
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Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market…
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Pharmacists have been shown to be beneficial for inclusion in emergency department (ED) services; however, little has been done to assess these benefits with pharmacists having even wider scopes of…
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There has been a dramatic increase in the authority granted to nurse practitioners (NP) and physician assistants (PA). This “expanded” authority has changed who can provide health‐care services and has…
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Strengthening health care overall is essential to the health of our nation and promoting access to health care as well as controlling health care costs in a quality cost-effective manner….
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“The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in…
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Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different…
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Occupational licensing laws have been relaxed in a large number of US states to give nurse practitioners the ability to perform more tasks without the super-vision of medical doctors. We…
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Nonphysician providers (NPPs) increasingly perform imaging-guided procedures, but their roles interpreting imaging have received little attention. We characterize diagnostic imaging services rendered by NPPs (i.e., nurse practitioners and physician assistants)…
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This paper considers how the decision to enter advanced practice nursing (e.g., the occupations of nurse practitioner, certified nurse-midwife, nurse anesthetist, and clinical nurse specialist) is affected by State laws…
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“Little is known about the geographic distribution of the overall primary care workforce that includes both physician and nonphysician clinicians–particularly in areas with restrictive nurse practitioner scope-of-practice laws and where…
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“Policymakers and clinicians are concerned that future growth in demand for health care services will exceed current provider supply. One potential solution to meeting this demand is expanding the number…
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“Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full…
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The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician…
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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…
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This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13…
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The summary goes here Douglas W Roblin, David H Howard, Edmund R Becker, E Kathleen Adams, and Melissa H Roberts Health Services Research June 2004 External Link

State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality…
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Patients can hold physicians directly or vicariously liable for the malpractice of nurse practitioners under their supervision. Restrictive scope-of-practice laws governing nurse practitioners can ease patients’ legal burdens in establishing…
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The increased use of nurse practitioners (NPs) and physician assistants (PAs) represents an important option for increasing access to healthcare. I explore the effect of two types of laws on…
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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…
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Higher health care prices in the United States are a key reason that the nation’s health spending is so much higher than that of other countries. Our study compared physicians’…
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This policy paper builds on FTC staff competition advocacy comments that focus on proposed state-level changes to statutes and rules governing the “scope of practice” of Advanced Practice Registered Nurses…
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The issue of occupational regulation has been of academic interest from Adam Smith to Milton Friedman (Friedman 1962; Smith 1937). In Western democracies, the number of workers who are required…
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In this issue of JAMA, Papanicolas and colleagues compared health care spending in the United States with health care spending in a select group of 10 of the highest-income countries…
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Retail clinics are largely staffed by nurse practitioners (NPs) and are a popular destination for nonemergent care. We examined if there was a relationship between NP practice regulations and retail…
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One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the…
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The costs of primary care have been rising and access to it may become limited because of a possible shortage in primary care physicians. Some state governments have addressed this…
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A number of recent studies have called for an overhaul of licensure for health care professionals. Common themes of these studies are increased flexibility in scopes of practice (much of…
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In the United States, the authority to regulate medical professionals lies with the states. To practice within a state, clinicians must obtain a license from that state’s government. State statutes…
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We study the labor-market impacts of occupational licensing laws on nursing, an economically important occupation. States adopted licensing of registered and practical nurses at different times, which allows us to…
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Recent upheavals within health care delivery, technological advances, and changing attitudes among consumers have challenged and changed health professions licensure. At the same time, traditional regulatory frameworks remain in place….
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I argue here that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight…
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The length of time from the implementation of an occupational licensing statute (i.e., licensing duration) may matter in influencing labor market outcomes. Adding to or raising the entry barriers are…
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All of the regressions and test statistics generated to ascertain the effects on pharmacist availability consistently revealed the following: (1) Pharmacist-population ratios, the proxy for pharmacist availability, were found to…
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State medical boards discipline several thousand physicians each year. Although certain subgroups, such as those disciplined for malpractice, substance use, or sexual abuse, have been studied, little is known about…
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There are many more examples of ways in which public members can strengthen their boards by raising issues and concerns and introducing agenda items that licensee members are unlikely to…
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Unfortunately, I don’t expect the federal bureaucracy to usher in the reign of Milton Friedman’s Chicago School economics. But the federal regulatory process would likely pay less heed to local…
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State medical licensure boards are widely, if dimly, perceived as the keepers of the gate of the medical profession. When patients or their advocates are aggrieved by physicians, they sometimes…
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Disciplined physicians were more likely to practice in psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice than nondisciplined physicians and were older than the national physician population,…
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We show that in both countries occupational licensing has a large impact on wage determination. The wage premium associated with licensing stands at approximately 18 per cent in the US…
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We document a large increase in the cyclicality of the incomes of high-income households, coinciding with the rise in their share of aggregate income. In the United States, since top…
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A recent article in the Federation Bulletin by Shirley Svorny, comparing certification with licensure, suggests that medical licensure does not benefit consumers but, instead, serves the interests of physicians by…
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Licensing confers a special authority, both literally and figuratively, which increases the likelihood of dependency on licensed personnel. The inequality of information available to the public, compared to the professional,…
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Occupational licensing is among the fastest-growing labor market institutions in the U.S. economy. One of the key features of occupational licensing is that the law determines who gets to do…
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Instead of vetting physicians, the licensing apparatus provides an avenue for professional influence that has been used to restrict entry, limit competition, and preclude innovation in the provision of health…
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Health services professionals are confronting the challenge of maintaining and improving competence over the course of lengthy careers in diverse practice specialties. This article reviews the efforts of a selection…
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This study examines the role of variations in occupational licensing policies and practices in improving the outputs of services provided to consumers, and the effect of restrictive regulations on the…
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The accountabilities and operations of state medical boards can have significant implications for hospitals and health systems in terms of their efforts to ensure quality care and patient safety. This…
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Licensing of the health professions is an issue of public policy which has been under fire for years. Economists argue that licensing stifles competition and increases health care costs. Manpower…
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There are also considerations that relate to how the concept of a job analysis will be received by board members and licensees or certificants. First, it is important to determine…
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As recently as the late 1960s, most licensure boards were composed of individuals appointed or nominated by medical societies. Only slowly did judicial supervision and legislative control transform licensure boards…
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