Abstract
We examine whether relaxing occupational licensing to allow nurse practitioners (NPs)—registered nurses with advanced degrees—to prescribe medication without physician oversight improves population mental health. Exploiting time-series variation in independent prescriptive authority for NPs from 1990 to 2014, we find that broadening prescriptive authority leads to improvements in self-reported mental health and decreases in mental health–related mortality. These improvements are concentrated in areas that are underserved by physicians and among populations that have difficulty accessing physician-provided care. Our results demonstrate that extending independent prescriptive authority to NPs can help mitigate physician shortages and extend care to disadvantaged populations.
Highlights
Limited access to mental health care services in the United States is a major public health concern
While one in five Americans suffers from a mental illness, nearly one third of the U.S population lives in areas that are underserved by mental health care providers (Bureau of Health Workforce, 2016)
We examine whether allowing nurse practitioners (NPs)—a class of registered nurses with advanced degrees in nursing—to prescribe medication without physician supervision or collaboration is associated with improved mental health outcomes
Summary
Limited access to mental health care services in the United States is a major public health concern. Previous studies have focused primarily on policy efforts to improve access to physician-provided care, for example by increasing access to health insurance, mandating parity in reimbursement for mental health care services, or altering incentives for graduating physicians to enter either psychiatry or primary care, and find mixed results (see, for, example Finkelstein et al (2012); Cunningham (2009); Rabinowitz et al (2008)) In contrast to this line of work, we focus on a policy that can increase the accessibility of medical care for disadvantaged populations immediately and at a low cost: there are currently 222,000 NPs already licensed in the US who could prescribe if legislation permitted them to do so (AANP, 2015).
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