reference library

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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“Despite research indicating that health, cost, and quality of care outcomes in midwife-led maternity care are comparable with and in some case preferable to those for patients with physician-led care,…
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In recent years, college graduates have found themselves increasingly saddled with student loan debt. Even worse, many of these graduates fall behind on that debt sometimes through no fault of…
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Wisconsin issues four different types of credentials, which are: licenses, certificates, registrations, and permits. All types collectively are commonly referred to as credentials. For the purposes of this report, the…
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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 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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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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This report provides an overview of the need to expand professional, business, and commercial licenses (also known as “occupational licenses”) to various work-authorized immigrants. The report provides an overview of…
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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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COVID-19 and our response have caused economic disruption, forcing businesses to close and millions to become unemployed. Although we have seen some recovery, the number of people currently unemployed remains…
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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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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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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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I examine the effects of mandatory occupational licensure on the quality of Certified Public Accountants (CPAs) using the staggered state-level adoption of the 150-hour Rule (the Rule). Although the Rule…
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In A Fair Chance: Simple steps to strengthen and diversify the teacher workforce, NCTQ analysis reveals both astonishingly high numbers of elementary teacher candidates failing their professional licensing tests each…
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Nearly 30 percent of American jobs require a license today, up from less than five percent in the 1950s. For some professions, occupational licensing is necessary to protect the public…
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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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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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Political leadership from the governor was one of the strongest factors influencing whether or not licensing was reformed. Governors accomplished this in a myriad of ways. Both Michigan Governor Rick…
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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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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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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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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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Public choice theory has long been the dominant lens through which economists and other scholars have viewed occupational licensing. According to the public choice account, practitioners favor licensing because they…
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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 paper examines the existing research on the effects of occupational licensing and concludes with a discussion of possible reforms. Existing studies have yet to find a definitive link between…
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Many professionals in the financial services industry refer to themselves as financial advisers despite tremendous variation in business practices, compensation methods, and duties to act in the best interest of…
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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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We estimate the effects of removing the license requirement for hair braiding in Virginia in 2012. Using County Business Patterns and Nonemployer Statistics data from 2004 through 2014, we find…
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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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Occupational licensing is invariably justified as a means of protecting the public against incompetent and dishonest practitioners. The effect of mandatory licensure, however, is often to restrict entry into an…
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State licensing boards perform the important government function of regulating professions, but there is a concern that these boards can be captured by interest groups and pursue private, anticompetitive ends….
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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 describes the set of regulations that limit service provision to individuals or entities who meet state-established criteria. Despite claims that licensure increases service quality, the effect of licensure on…
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Self-regulation encompasses a wide range of arrangements, from private ordering without resort to legal rules to state-enforced systems of delegated rules. Transaction cost analysis has been used to explain how…
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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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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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This book provides a detailed, nontechnical overview of occupational licensing in the United States, China, the United Kingdom, and the European Union for students of the labor market, consumers, the…
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State policymakers play an important role in setting licensure policy and are at the heart of many efforts to strike the right balance needed to protect consumers and promote economic…
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Although the topic of state licensing has received voluminous exposure, city occupational licensing remains a part of the law that has been hurriedly bypassed. A closer look at this level…
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I analyse occupational licensing as an input regulation that requires minimum levels of human capital investment by professionals. By raising professionals’ training levels, licensing helps alleviate moral hazard problems associated…
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The economic theory of regulation suggests that occupational licensing laws are enacted and administered to advance the interests of licensed practitioners. For example, grading standards on licensing examinations could be…
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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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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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If the extreme judicial deference epitomized by the rational basis test is the wrong approach to economic legislation, what is the right approach? One answer is that economic rights should…
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This paper explores the origins and effects of occupational licensing regulation in late nineteenth and early twentieth century America. Was licensing regulation introduced to limit competition in the market for…
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As the role of mortgage brokers in mortgage origination grew from insignificant in the 1980s to dominant in recent years, questions have arisen about whether its services help or harm…
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Thus, allow me to suggest a couple of “second-best” options that may have a better chance of making a more immediate impact.First, conduct periodic occupational licensing reviews. In addition to…
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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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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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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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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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Right touch is relatively new on the regulatory scene and its efficacy remains to be fully demonstrated, particularly outside of the U.K. and in occupations and professions beyond health care….
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Many of these arbitrary regulations are passed at the request of professional associations and government boards that want to protect the pocket books of their members by shutting out new…
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As the quantity and scope of regulations in Florida grow, so does the degree to which they affect the economy. In these circumstances, a little reform to the process of…
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We contend that the state action doctrine should not prevent antitrust suits against state licensing boards that are comprised of private competitors deputized to regulate and to outright exclude their…
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Occupational licensing has been among the fastest growing labor market institutions in the United States since World War II. The evidence from the economics literature suggests that licensing has had…
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In this paper I use a rich longitudinal database from Florida to compare the characteristics of alternatively certified teachers with their traditionally prepared colleagues. I analyze the relative effectiveness of…
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Dental Examiners, moreover, calls for more than a fig leaf of bureaucratic supervision. Superficial reforms will leave states open to considerable legal uncertainty, as the Supreme Court has not clearly…
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Occupational licensing directly affects nearly 30 percent of U.S. workers today and continues to grow in density and scope. In this article, we identify and analyze those rare instances when…
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If licensing places too many restrictions on this allocation of workers, it can reduce the overall efficiency of the labor market. When workers cannot enter jobs that make the best…
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Chairman Lee, Ranking Member Klobuchar, and Members of the Subcommittee: thank you for the opportunity to appear here today to testify about occupational licensing. This is an important economic issue,…
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This paper examines the evidence that the pay gap [among highly-paid professionals] is due to protectionist measures that restrict competition. The most important of these protectionist measures are licensing practices…
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In July 2015, the White House put out a set of best practices for state policymakers to enact reforms to reduce the prevalence of unnecessary and overly broad occupational licenses…
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