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The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid

      Introduction

      The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. healthcare system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges.

      Aim

      To estimate the impact of expanded NP scope of practice (SOP) regulations on the costs of total outpatient visits, prescription drugs, and total care days received by Medicaid beneficiaries nationwide from 1999–2011.

      Methods

      We used a longitudinal data policy analysis framework and built a fixed-effect model, a generalized form of a difference-in-differences model, to identify the effect of changes in NP SOP regulations on the outcome variables. The models included controls for state income and unemployment rates.

      Results

      Compared to states with reduced SOP, states with full SOP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year). States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). Annual total care days were 8% (i.e., 819,905.9 days) higher in states with full SOP compared to states with reduced SOP (p = .05).

      Conclusion

      States that expand NP SOP may provide greater intensity of care (measured using total care days) to Medicaid patients without increasing total costs of care.

      Keywords

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      Biography

      Lusine Poghosyan, PhD, MPH, RN, FAAN, is Associate Professor, Columbia University School of Nursing, New York, New York.

      Biography

      Edward J. Timmons, PhD, is Professor of Economics and Director, Knee Center for the Study of Occupational Regulation, St. Francis University, Loretto, Pennsylvania.

      Biography

      Cilgy M. Abraham, BS, RN, is a PhD Student, Columbia University School of Nursing.

      Biography

      Grant R. Martsolf, PhD, MPH, RN, FAAN, is Professor, University of Pittsburgh School of Nursing, Department of Acute and Tertiary Care, and an Adjunct Policy Researcher, RAND Corporation, Pittsburgh, Pennsylvania.

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      • Conflict of Interest Compliance Article 4
        Journal of Nursing Regulation Vol. 12Issue 2
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          As is standard in scholarly publishing, NCSBN’s Journal of Nursing Regulation (JNR) requires its authors to disclose any potential conflicts of interest (COI). Although COI information has always been collected by our staff in order to support editors’ review of the paper, it was not our standard practice to publish COI statements in each article. In this issue, JNR is retrospectively publishing the COI statements, which were collected with the below papers at submission, in order to make potential COI’s transparent to readers, as well as editors.
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