Healthcare Provider Regulations and Maternal Health: Linking Access to Pregnancy Outcomes

• In Event: Implications of Scope of Practice Reform for Advanced Practice Registered Nurses

Abstract

The United States faces a growing shortage of healthcare providers while experiencing an increase in adverse pregnancy outcomes. While policymakers have proposed expanding scope of practice by granting Full Practice Authority (FPA) to Certified Nurse Midwives (CNMs) as a potential solution, limited evidence exists on how FPA affects the provision of healthcare during a pregnancy episode. We use individually tracked commercial claims data to construct pregnancy episodes and use state-level scope-of-practice (SOP) regulations to explore the effect of FPA on prenatal care and pregnancy outcomes using a staggered difference-in-differences research design. Our findings reveal that FPA significantly increases access to care and overall use of services on both the intensive and extensive margin as measured by evaluation and management (E&M) claims. Interestingly, we find evidence of physician spillovers as OB-GYN provided E&M visits increase while the share of services provided by physicians by OG-GYN in a pregnancy episode has a small decline (about 1.1%). Additionally, we find that FPA is associated with a 1.2 percentage point (approximately 3.3%) reduction in cesarean sections, although this is accompanied by increased rates of reported miscarriages likely driven by increased participation in prenatal visits. We generally observe no effects for preterm births and severe maternal mortality.

Authors

• Moiz Bhai, University of Arkansas
  Presenting Author

• Danny Hughes, Arizona State University
  Non-Presenting Co-Author