On June 13, the Brookings Institution released a new policy proposal titled Improving Efficiency in the Health-Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants written by Emory University professors Kathleen Adams and Sara Markowitz. The authors consider the evidence, which shows barriers that states place on the scope of practice for NPs and PAs increase healthcare costs and add administrative burdens without additional health and safety benefits. The report includes recommendations that state policymakers eliminate supervision requirements and allow full prescription authority to advanced practice registered nurses.
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 be achieved by altering the mix of labor inputs used in the health-care sector. However, the potential for these gains is sharply limited by anticompetitive policy barriers in the form of restrictive scope of practice (SOP) laws imposed on physician assistants and advanced practice registered nurses. In this proposal we discuss evidence that shows how these laws restrict competition, generate administrative burdens, and contribute to increased health-care costs, all while having no discernable health benefits. We discuss how moving to a fully authorized SOP for these providers can free up labor markets, allowing for a more-cost-effective and more-productive use of practitioners, while potentially fostering innovation and still protecting public health. A key outcome would be improved access to care as gains in productivity increases capacity in the health-care system. We conclude with a discussion of state and federal policies that either remove these barriers directly or encourage state legislative bodies to do so.