Health Outcomes and Provider Choice under Independent Practice for Certified Nurse-Midwives

73 Pages Posted: 7 Jul 2021

See all articles by Lauren Hoehn-Velasco

Lauren Hoehn-Velasco

Georgia State University - Andrew Young School of Policy Studies

Diana Jolles

Frontier Nursing University

Adan Silverio-Murillo

School of Government, Tecnologico de Monterrey

Alicia Plemmons

Southern Illinois University Edwardsville

Date Written: May 31, 2021

Abstract

This study examines whether full practice authority for certified nurse-midwife (CNMs) affects obstetric outcomes. Using U.S. birth certificates over 2008-2019, we track labor & delivery characteristics before and after states enacted CNM full practice authority. We find little change in health outcomes, but we discover a one percentage point increase in CNM-attended deliveries. The observed increase in CNM-attended deliveries is most apparent in states that passed full practice authority post-2010 and is not present in states that passed prescriptive authority or pre-2010 reforms. Based on the heterogeneous effects, we explore the contribution of other state-level policies, including certificate-of-need laws, the Affordable Care Act (ACA) Medicaid expansions, and the general passage of the 2010 ACA. Overall, our findings suggest that the impact of full practice authority may be context-dependent, with the effects sensitive to reform timing and state-level policies in place.

Note: Funding: None.

Declaration of Interest: The authors have no conflicts of interest to declare.

Keywords: Scope of practice, full practice authority, occupational licensing, maternal health, infant health, certified nurse-midwife, consumer safety, Affordable Care Act.

JEL Classification: I18, I11, K0, J44

Suggested Citation

Hoehn-Velasco, Lauren and Jolles, Diana and Silverio-Murillo, Adan and Plemmons, Alicia, Health Outcomes and Provider Choice under Independent Practice for Certified Nurse-Midwives (May 31, 2021). Available at SSRN: https://ssrn.com/abstract=3878127 or http://dx.doi.org/10.2139/ssrn.3878127

Lauren Hoehn-Velasco (Contact Author)

Georgia State University - Andrew Young School of Policy Studies ( email )

Department of Economics
35 Broad Street, 6th Floor
Atlanta, GA 30303-3083
United States

Diana Jolles

Frontier Nursing University ( email )

United States

Adan Silverio-Murillo

School of Government, Tecnologico de Monterrey ( email )

Calle del Puente 222
Mexico City, 04210
Mexico

Alicia Plemmons

Southern Illinois University Edwardsville ( email )

Edwardsville, IL 62026
United States

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