Regulations and Markets for Health Care Providers
The papers in this session examine how various state and federal regulations affect the recruitment and practice of health care providers. The laws examined in the different papers pertain to immigration, malpractice insurance, and scope of practice. As the papers demonstrate, these laws have broad influence and the potential for severe unintended consequences, particularly in medically underserved areas. The first paper examines how changes in a federal immigration policy pertaining to foreign medical students affects the demand for residents by hospitals. The paper shows that the stricter policy reduces the demand for foreign residents and replaces them with US citizens. The authors show that this compositional change negatively affects the supply of physicians to underserved areas. The second paper also looks at the market for medical residents and examines how state-based malpractice insurance reforms affect the locational decisions of new physicians. This work also examines the types of physicians that choose certain areas. The results in this paper have implications for the dispersion of the physician labor force across the country and into shortage areas. The final paper focuses on state regulation of scope of practice for advance practice registered nurses. This work examines how the degree of restrictions on practice for certified nurse midwives affects the labor market for these nurses and quality of care as measured by maternal and child outcomes. Results indicate that restrictive SOP laws serve as artificial barriers rather than protecting the public health.