The shortage of nurse practitioners in the United States has broadly decreased access, decreased quality, and increased care costs. In some states, policymakers are trying to address such shortages ...by expanding nurse practitioners’ scope of practice or extending autonomy for nurses to order tests, prescribe medications, diagnose patients, and initiate and manage treatments. We exploit the state-level variations in the nurse practitioner’s scope of practice laws to estimate the impact on the mobility decisions of the nurse who serve Medicare beneficiaries. We identify nurse’s practice locations from 2013 to 2017 by gleaning their National Provider Identifiers from Part D Prescriber Public Use File data. We find that nurses in full-practice states are 0.41 percent less likely to move out of the state compared to nurses in restrictive-practice states. Also, nurses who move are 5.70 percent more likely to move to full-practice states than restrictive-practice states. Our estimates demonstrate nurses’ preference for practicing in states with the full scope of practice.
Due to a growing physician shortage, patients have difficulty accessing primary care. In an effort to expand access and support patient health, many states are reducing barriers for advanced practice ...registered nurses to provide primary care without physician collaboration. Maryland provides an interesting case study. We leverage Maryland's policy change to explore the effects of full practice authority (FPA), focusing on the number of professionals and health outcomes for patients. Employing a border county comparison between Maryland and Pennsylvania, we estimate the effect of FPA. Our analysis of health outcomes focuses on three county-level health outcomes: poor or fair health, poor mental health days, and preventable hospital stays. We find that FPA is associated with increases in the number of certified nurse midwives by 0.6 per 100,000 residents and nurse practitioners by 22.4 per 100,000 residents. We also find evidence of an association of FPA with reductions in the share of residents who report being in poor or fair health by 2.8 percentage points and poor mental health days per month by 0.354 days per person. Combined, our results provide suggestive evidence that moving to FPA improves access to care and leads to improved health outcomes for Maryland residents. Removing regulatory barriers that prevent certified nurse midwives and nurse practitioners from working to the full extent of their training may increase access to primary care and improve patient outcomes.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
Rising inequality in the US, and resulting economic and wage stagnation, has been attributed to the growing productivity-compensation gap. Academics and policy makers have puzzled over the source of ...the gap since the 1970s. We hypothesize that the observed gap is misleading because productivity spillovers only partially translate into increased compensation. We analyze productivity spillovers with a spatial dimension, such that the industrial productivity of one state spills over to that of contiguous states. To do so, we employ a unique data set and spatial econometric techniques, including a spatial two-stage least squares instrumental variable approach and the spatially lagged X framework. The data set includes state-level industry panel data on employment, compensation, and gross industrial output for sixty-six industries within the forty-eight continental US states from 1998 to 2017. Once we account for productivity spillovers within industries, the gap between labor compensation and productivity narrows significantly.
In this study, we examine how full nurse practitioner (NP) practice authority affects racial and ethnic diversity of the NP workforce. Specifically, the purpose of our research is to understand the ...relationship between the racial and ethnic composition of the NP workforce, NP level of practice authority, and the communities they service. In this paper, we compare the ethnic and racial composition of the NP workforce to the composition of the state's population, and then observe if there are any noticeable differences in the patients served by NPs when we compare full practice authority (FPA) and non-FPA states. We also estimate how FPA affects the race and ethnicity of Medicare patients served by NPs.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
•The opioid overdose crisis remains a chief public health concern in the United States.•Buprenorphine availability for opioid use disorder treatment remains limited.•Medicaid expansion states with ...pain management clinic (pill mill) laws had higher treatment availability.•Limiting opioid supply while improving buprenorphine access is a promising strategy.
Background: The opioid overdose crisis remains of critical concern after historic increases in overdose mortality in the United States between 2020 and 2021. Improving access to buprenorphine —a partial opioid agonist and one of three FDA-approved medications for opioid use disorder (OUD) treatment— and reducing inappropriate opioid prescriptions may help curb mortality. Here, we examined the impact of Medicaid expansion and pain management clinic laws on opioid prescription rates and buprenorphine availability. Methods: We examined both retail opioid prescriptions per 100 persons in the state population using data from the Centers for Disease Control and Prevention and data on buprenorphine distributions in kilograms per 100,000 persons in the state population from the Automated Reports and Consolidated Ordering System database. We employed difference-in-difference frameworks to estimate the impact of Medicaid expansion on buprenorphine access and retail opioid prescription rates. Models considered three separate treatment variables: Medicaid expansion, pain management clinic (“pill mill”) laws, and the interaction of Medicaid expansion and pain management clinic laws. Results: Findings showed that Medicaid expansion was associated with increased access to buprenorphine in expansion states that also employed more stringent supply-side policies, including pain management clinic laws, relative to states that did not implement policies targeting the over-supply of prescription opioids over the same time period. Conclusions. Together, Medicaid expansion and policies limiting inappropriate opioid prescriptions show promise for improving the accessibility of buprenorphine treatment for OUD.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We examine hospital-level CCR – charges to Medicare-allowable costs – from 2011 to 2022 among governmental, for-profit, and non-profit hospitals and identify hospitals that charged extreme CCR of ...over 1000% of the cost. We tracked hospitals that experienced ownership transitions and found that governmental and non-profit hospitals’ average CCR increased by 161% and 99.7%, respectively, after transitioning to become for-profits. These higher CCRs affect uninsured patients, out-of-network patients, and casualty and workers’ compensation insurers.
•We identify about 147 hospitals Charge-to-cost ratio (CCR) of more than 1000%.•Governmental and non-profit hospitals’ CCR rose 161% and 99.7%, respectively, after transitioning to for-profits.•Higher CCRs affect uninsured patients, out-of-network patients, and casualty and workers’ compensation insurers.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We investigate the interplay between energy prices and drilling activities in the United States and how this relationship has evolved due to the shale revolution. We hypothesize that (1) there exists ...significant information spillover between drilling activities and energy prices; (2) the amount of information transmitted between drilling activities and energy prices has increased since the shale boom; (3) natural gas market is increasingly important information transmitter since the rise of unconventional oil and gas production. Using connectedness indexes constructed based on vector autoregressive models and data from 1997 to 2019, we find support for all three hypotheses. In particular, the linkage between drilling activities, measured by active rotary rigs in operation, and oil and gas prices in the US has strengthened since 2012. Oil and gas drilling activities have become more responsive to price variations during the shale revolution. However, the information transmitted from oil prices to rig count declined when oil prices fluctuated in a relatively stable range toward the end of the sample period. In contrast, the information transmitted from gas prices to gas rig counts has increased during the same time frame.
•Information transmission between drilling activities and energy prices is examined.•Drilling activities are more responsive to energy price changes since the shale boom.•Oil prices remain the largest information transmitter in the energy sector.•Natural gas increasingly important in transmitting external shocks.•No evidence for “delinked” oil and gas markets when accounting for drilling activities.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This paper examines the effect of prescription drug monitoring programs (PDMPs) on the retail sales of eight commonly prescribed opioids in the United States. Specifically, we exploit variation in ...state‐level policies to identify states with “must‐access” versus voluntary PDMPs. Our results suggest that must‐access PDMP implementation does not uniformly reduce prescription retail opioid sales. We also find evidence that must‐access PDMP implementation does not affect the retail sales of two treatment drugs, methadone and buprenorphine. These results suggest that policymakers should consider PDMP implementation as part of a broader response to the opioid crisis rather than a singular policy intervention.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
•We study the impact of the 2015 earthquake on international labor migration in Nepal.•We apply different sets of difference-in-differences research design.•Number of work permits issued to Nepalese ...individuals for international migration decreased in districts severely affected by the earthquake.•We do not find a statistically significant effect of the earthquake on work permits issued to females.
The 2015 earthquake in Nepal affected approximately 8 million people, resulting in an economic loss of 10 billion US dollars. We exploit the quasi-random spatial and temporal nature of ground tremors to evaluate the impact of the 2015 earthquake on international labor migration per 100,000 population in Nepal. Using different sets of difference-in-differences research designs, we show that the number of work permits issued to Nepalese individuals for international migration decreased significantly in districts severely affected by the 2015 earthquake. Results further indicate that the effect of the earthquake on international labor migration is statistically significant and negative only among males. Together, these results provide strong evidence that natural disasters induce significant changes in labor market outcomes in a developing country setting.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
