Doctoral Dissertation Research in Economics: The Effect of Certified Nurse Midwife Scope-of-Practice Laws on Health Costs, Prices, and Outcomes

经济学博士论文研究：注册护士助产士执业范围法对健康成本、价格和结果的影响

• 批准号: 2018061
• 负责人: Gautam Gowrisankaran
• 金额: $ 2.44万
• 依托单位: National Bureau of Economic Research Inc
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2021-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2018061&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Economics; Effect

This research project will study the effects of changes in scope of practice (SOP) laws on hospital cost, price of health services, and the quality of health care. Specifically, this research studies whether changing SOP laws to allow Certified Nurse Midwives (CNMs) to provide obstetrics care without the supervision of medical doctors (MDs) reduce the hospital cost of giving birth without reducing the quality of care and if this cost savings are passed on to patients by charging lower prices. The research will also study the mechanisms through which allowing CNMs more independence lead to cost savings in the provision of birth services reduces cost. The researchers will use hospital data from seven states that recently have changed SOP laws. This research project studies an important economic issue that has important policy implications. The research results will provide guidance on how to decrease or slow the growth rate of health care cost. This can help establish the U.S. as the global leader in healthcare cost reforms. This research project leverages quasi-random variation in the strictness of SOP laws across states and time to estimate the effect of relaxing these laws on hospital cost, service quality, and pass-through of cost savings to patients. Using generalized difference-in-difference and event-study methods, the study will: (i) identify the causal impact of SOP laws on costs; (ii) estimate whether these savings are passed on to consumers via reductions in price or increases in quality; (iii) examine how market structure mediates these effects; and (iv) identify causal mechanisms for the effects of SOP laws. This approach will be able to estimate the causal effect of relaxing SOP laws because it adjusts for fixed differences across states that change their laws and those that do not. The effect is unlikely to be confounded by differential trends in the outcome of interest because political processes drive the timing of SOP law changes and these changes are unrelated to trends in the outcomes of interest. Finally, states adopt new SOP laws at different times, making it unlikely that there are other simultaneous shocks that would confound the effect of the policy. The project’s detailed discharge-level data will enable it to calculate more precise measures of cost and resource use. Finally, the detailed data can help estimate the relative importance of different causal mechanisms. The results of this research can help establish the U.S. as the global leader in healthcare cost reforms.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

该研究项目将研究执业范围 (SOP) 法律的变化对医院成本、医疗服务价格和医疗保健质量的影响。具体而言，本研究研究是否更改 SOP 法律以允许注册护士助产士 (CNM)。在没有医生（MD）监督的情况下提供产科护理可以在不降低护理质量的情况下降低医院的分娩成本，并且如果通过收取较低的价格将这种成本节省转嫁给患者，该研究还将研究其机制。赋予 CNM 更大的独立性研究人员将使用最近修改了 SOP 法律的七个州的医院数据，研究一个具有重要政策影响的重要经济问题。如何降低或减缓医疗保健成本的增长率。这可以帮助美国成为医疗保健成本改革的全球领导者。该研究项目利用各州 SOP 法律严格程度和时间的准随机变化来估计效果。放宽有关医院费用、服务的法律使用广义双重差分法和事件研究方法，该研究将：(i) 确定 SOP 法律对成本的因果影响；(ii) 估计这些节省是否是有效的。通过降低价格或提高质量传递给消费者；(iii) 研究市场结构如何调节这些影响；以及 (iv) 确定 SOP 法律影响的因果机制。 SOP 法，因为它针对固定的情况进行调整改变法律的州和不改变法律的州之间的差异不太可能被利益结果的差异趋势所混淆，因为政治进程推动了 SOP 法律变化的时间，而这些变化与利益结果的趋势无关。最后，各州在不同时间采用新的 SOP 法律，因此不太可能出现其他同时发生的冲击，从而影响该政策的效果。该项目的详细排放水平数据将使其能够计算出更精确的成本和资源使用指标。最后，详细的数据可以帮助估算这项研究的结果可以帮助美国成为医疗保健成本改革的全球领导者。该奖项反映了 NSF 的法定使命，并通过使用基金会的智力价值和更广泛的影响进行评估，认为值得支持。审查标准。