Occupational Licensing and Legal Liability: The Effect of Regulation and Litigation on Nurse Practitioners, Physician Assistants, and the Healthcare System

Abstract

As millions of new patients enter the healthcare system in the wake of the Affordable Care Act, the greater use of nurse practitioners (NPs) and physician assistants (PAs) represents an important option for increasing the availability and decreasing the cost of healthcare. However, state occupational licensing laws restrict the capacity of NPs and PAs to provide healthcare in many states, and the threat of malpractice liability may adversely impact the practices of these professionals. In this dissertation, I first explore the political determinants of licensing laws and find that political contributions by physician and hospital interest groups play a salient role in the adoption of less restrictive licensing laws. I next consider the effect of licensing laws and tort reforms on the location decisions of NPs and PAs and find that both sets of laws affect where NPs and PAs decide to supply healthcare. Finally, I find that while broader licensing laws have an ambiguous effect on healthcare quality, they generally increase the use of preventative cancer screenings. Some tort reforms, on the other hand, reduce these screenings.