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

本研究计划将研究实践范围（SOP）法律的变化对医院成本、医疗服务价格和医疗服务质量的影响。具体而言，本研究旨在研究改变SOP法律，允许注册护士助产士（CNMs）在没有医生（MDs）监督的情况下提供产科护理，是否会在不降低护理质量的情况下降低医院的分娩成本，以及这种成本节约是否会通过降低价格转嫁给患者。该研究还将研究使cnm更加独立从而在提供分娩服务方面节省成本的机制，从而降低成本。研究人员将使用最近修改了SOP法律的七个州的医院数据。本研究项目研究一个具有重要政策意义的重要经济问题。研究结果将对如何降低或减缓医疗成本的增长速度提供指导。这有助于确立美国在医疗成本改革方面的全球领先地位。本研究项目利用不同州和时间SOP法律严格程度的准随机变化来估计放宽这些法律对医院成本、服务质量和节省成本给患者带来的影响。本研究将采用广义差中差和事件研究方法：(i)确定SOP法规对成本的因果影响；（ii）估计这些节省是否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；（iv）确定SOP法律影响的因果机制。这种方法将能够估计放宽SOP法律的因果效应，因为它调整了改变法律和不改变法律的州之间的固定差异。这种影响不太可能被利益结果的不同趋势所混淆，因为政治过程推动了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，各州在不同的时间采用新的SOP法律，这样就不太可能同时出现其他影响政策效果的冲击。该项目详细的排放水平数据将使其能够更精确地计算成本和资源使用情况。最后，详细的数据可以帮助估计不同因果机制的相对重要性。这项研究的结果可以帮助美国成为全球医疗成本改革的领导者。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

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.