Full Citation

Title: Evidence from the Medical Expenditure Panel Survey on Patient Cost of Care Provided by Nurse Practitioners

Citation Type: Dissertation/Thesis

Publication Year: 2021

ISBN:

ISSN:

DOI: 10.22004/AG.ECON.309652

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Abstract: Nurse practitioners (NPs) are able to complete training and enter the workforce faster than physicians, and they have labor cost advantages. Since they are able to provide many of the same primary care services as physicians, utilizing them as independent providers may help improve access to healthcare and contain costs. Prior evidence has shown NPs achieve patient satisfaction and health outcomes that are on par with or better than those of physicians. There is also some evidence to indicate that NP practice patterns result in similar or lower patient medical expenditures when compared to physician care. However, this evidence is limited, with little study at the national level. In an effort to contribute evidence, I use data from the 2015 and 2016 Medical Expenditure Panel Survey (MEPS) to examine whether a greater ratio of patient NP visits to total NP and physician visits is associated with a lower level of expenditures. Because of unobserved confounders, particularly those associated with the generally healthier case mixes of NPs, I estimate both an OLS and a 2SLS model. The 2SLS model uses as an instrument the percentage of providers at the respondent’s usual source of care who are NPs or PAs. Patients’ capacity for choice at the facility level is expected to be less than that at the provider level within facilities, thereby reducing the magnitude of selection bias. I find from the OLS model that an increase of one point in the percentage of visits to NPs is associated with a statistically significant decrease in expenditures of .24%. The corresponding 2SLS estimate is a decrease of 1.13%, but based on the commonly used cutoff of an F-statistic of 10, the instrument appears to be weak. I cannot rule out the possibility that these estimates are negative only because of selection bias. An extension of this analysis involving applying for access to restricted geographic information would enable merging MEPS data with county-level NP and physician counts from the Area Health Resource Files. County provider distribution may be a less endogenous instrument, alleviating concerns over selection bias.

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Authors: Eklund, Jesse

Institution: University of Minnesota

Department: Economics

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Pages: 1-72

Data Collections: IPUMS Health Surveys - MEPS

Topics: Population Health and Health Systems

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