How does provider supply and regulation influence health care markets? Evidence from nurse practitioners and physician assistants

J Health Econ. 2014 Jan;33:1-27. doi: 10.1016/j.jhealeco.2013.10.009. Epub 2013 Oct 26.


Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of these professions has occurred amidst considerable cross-state variation in their regulation, with some states permitting autonomous practice and others mandating extensive physician oversight. I find that expanded NP and PA supply has had minimal impact on the office-based healthcare market overall, but utilization has been modestly more responsive to supply increases in states permitting greater autonomy. Results suggest the importance of laws impacting the division of labor, not just its quantity.

Keywords: Health care workforce; I11; J44; Occupational licensing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data
  • Government Regulation*
  • Health Care Costs
  • Health Care Sector / economics
  • Health Care Sector / legislation & jurisprudence*
  • Health Care Sector / organization & administration
  • Health Care Sector / statistics & numerical data
  • Health Expenditures / statistics & numerical data
  • Humans
  • Nurse Practitioners / legislation & jurisprudence
  • Nurse Practitioners / supply & distribution*
  • Physician Assistants / legislation & jurisprudence
  • Physician Assistants / supply & distribution*
  • State Government
  • United States
  • Workforce