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

这项研究项目将研究业务范围(SOP)法律的变化对医院成本、卫生服务价格和卫生保健质量的影响。具体地说，这项研究研究修改SOP法律，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，是否在不降低护理质量的情况下降低医院分娩成本，以及是否通过收取更低的价格将节省的成本转嫁给患者。这项研究还将研究允许CNM更多地独立导致在提供分娩服务方面节省成本降低成本的机制。研究人员将使用最近修改了SOP法律的七个州的医院数据。这项研究项目研究了一个具有重要政策含义的重要经济问题。研究结果将为如何降低或减缓医疗费用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。这项研究项目利用SOP法律在各州和时间上的严格程度的准随机变化来估计放松这些法律对医院成本、服务质量和将成本节省传递给患者的影响。使用广义差异法和事件研究法，本研究将：(I)确定SOP法律对成本的因果影响；(Ii)估计这些节省是否通过降价或提高质量转嫁给消费者；(Iii)考察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。这种方法将能够估计放松SOP法律的因果影响，因为它调整了改变法律的州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，因为政治进程决定了SOP法律变化的时机，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，因此不太可能同时出现其他冲击，扰乱该政策的效果。该项目详细的排放水平数据将使其能够更准确地计算成本和资源使用的衡量标准。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。这项研究的结果有助于将美国确立为医疗成本改革的全球领导者。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势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.