Health outcomes and provider choice under full practice authority for certified nurse-midwives

Lauren Hoehn-Velasco, Diana R. Jolles, Alicia Plemmons and Adan Silverio-Murillo

Journal of Health Economics, 2023, vol. 92, issue C

Abstract: Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008–2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Keywords: Scope of practice; Full practice authority; Occupational licensing; Maternal health; Infant health; Certified nurse-midwife; Consumer safety; Affordable Care Act (search for similar items in EconPapers)
JEL-codes: I11 I18 J44 K0 (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:92:y:2023:i:c:s0167629623000942

DOI: 10.1016/j.jhealeco.2023.102817

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