The Impact of Nurse Practitioner Scope-of-Practice Regulations in Primary Care

by Aziza Arifkhanova

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The costs of primary care have been rising and access to it may become limited because of a possible shortage in primary care physicians. Some state governments have addressed this issue by allowing Advanced Practice Registered Nurses (APRNs) to serve the population without the supervision of physicians. About half of the states permit nurse practitioners (NPs) to practice and/or prescribe drugs without physician supervision or collaboration. NPs in primary care charge lower prices than physicians and provide satisfactory quality of care, supported by existent literature. Moreover, increasing the number of NPs could alleviate access problems from a low supply of physicians. NP scope-of-practice (SOP) regulations have been changing in many states. The dissertation focuses on access to health care and addresses three research questions: what is the impact of NP SOP regulations on NP employment, access to primary health care in areas characterized by a relatively low supply of primary care physicians, and how does the Center for Medicaid and Medicare Innovation's Comprehensive Primary Care Initiative affect the use of NPs given state SOP regulations?

Table of Contents

  • Chapter One


  • Chapter Two

    Background and Literature Review

  • Chapter Three

    Theory and Conceptual Framework for Nurse Practitioner Scope-of-Practice

  • Chapter Four

    The Impact of Nurse Practitioner Scope-of-Practice on Nurse Practitioner Employment

  • Chapter Five

    The Impact of Nurse Practitioner Scope-of-Practice on Patient Volume

  • Chapter Six

    The Center for Medicare and Medicaid Innovation's Comprehensive Primary Care Initiative and Nurse Practitioner Scope-of-Practice in Primary Care

  • Chapter Seven


  • Appendix A1

    Description of steps for cleaning SK&A data

  • Appendix A2

    CMMI's CPCI: Background

  • Appendix A3

    Tables and Figures

Research conducted by

This document was submitted as a dissertation in August 2017 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of James Hosek (Chair), Grant Martsolf, and Chapin White.

This publication is part of the RAND Corporation Dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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