The Effects of Nurse Scope of Practice Laws on Healthcare Spending, Prices, and Access

In recent years, many states have implemented expanded scope of practice laws that allow nurses to perform a greater share of health care services and prescribe medications. This study examines how these laws impact spending, prices, and the volume of care for common office-based visits. Using data from the Health Care Cost Institute (HCCI) and its data contributors—Aetna, Humana, and UnitedHealthcare—we examined medical claims for approximately 50 million individuals who were covered in the years 2008-2012. We also used the National Plan and Provider Enumeration System (NPPES) data to identify providers who perform primary care services. To estimate the effects of independent scope of practice for NPs, we estimate a difference-in-differences regression at the state-, year-, and procedure code-level. We find a 2.8% increase in spending, which is driven by a 7.1% increase in the volume of care, but no change in prices. This increase is largest for complex office visits, which have a 20.8% increase in spending and a 16.3% increase in volume relative to non-complex office visits. Our results suggest that scope of practice laws do not decrease spending but may increase access to primary care services.