An Empirical Assessment of Occupational Licensing Reforms in the Healthcare Sector
This dissertation studies how reforms to state issued occupational licenses affects labor market outcomes for nurses and health outcomes for consumers. Chapter one studies the effect of the Nurse Licensure Compact (“Compact”) on labor market, geographic, and educational outcomes for registered nurses. Using a rich individual-level dataset, this chapter demonstrates that the Nurse Licensure Compact reduced employment and wages for nurses but eased geographic mobility within Compact states. This chapter also finds that the Compact induced individuals to enter higher education programs. Chapter two investigates the effect of the Nurse Licensure Compact on labor market outcomes for military-spouse nurses. Individuals married to military personnel experience materially worse labor-market outcomes than their similarly situated peers married to civilians. Accordingly, the Compact may uniquely benefit this group of nurses. Using data from the American Community Survey, I find that the Compact increased employment for military-spouse nurses. Chapter three investigates the effect of independent practice for advanced practice registered nurses (“APRNs”) on patient health outcomes during the COVID-19 pandemic. During March and April 2020, fourteen states eliminated or reduced scope-of-practice restrictions for APRNs. I find consistent evidence that broader APRN scope-of-practice reduced non-COVID-19 fatalities by approximately three percent between January 26 and September 26, 2020. I also find some evidence that greater APRN independence reduced COVID-19 fatalities and case rates.