research (Selected works)
Abstract
Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority.
Abstract
The prescription-privileges movement has advocated for state laws enabling trained psychologists to prescribe psychotropic medication. We examine the impact of these laws on healthcare access and outcomes. Using staggered difference-in-differences analysis and Data Axle data, we estimate the number of new mental health establishments per 100,000 people after policy implementation. Using CDC data, we analyze the policy's impact on suicide rates. We find the policy increased the number of psychology and counseling practices without decreasing the number of psychiatric practices, implying that these practices are complements rather than substitutes. Quality held steady, with no notable change in the suicide rate.
testimony
educational one-pagers
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