Publication Date
2021
Abstract
Among the many challenges it has created, the COVID19 pandemic has exacerbated the United States' access-to-care problem. While millions of individuals have confronted this problem for years in the context of chronic disease management, mental illness, and other diseases and injuries, many Americans are facing serious access-to-care issues for the first time during the pandemic. Recognizing the acuity of this problem, states adopted temporary policies to combat it. One of the most important policy solutions has been the relaxation of state scope-of-practice laws that inhibit the ability of many healthcare providers, such as nurse practitioners, to deliver healthcare. These temporary relaxations offer insight into longer-term solutions to the longstanding access-to-care issues that pervade the American healthcare system.
While some states have changed their scope-of-practice laws to allow nurse practitioners to practice independently (on a permanent basis), many states have refused to do so, citing patient safety concerns. To evaluate these concerns, this Article examines the impact of relaxing these laws in the context of another familiar public health crisis-the opioid epidemic. This purported tension, between access and safety, is most directly studied in the context of the opioid epidemic, which arose within the healthcare system itself and is intimately connected to patient safety. The opioid epidemic is, therefore, an ideal setting in which to evaluate patient safety concerns.
Analyzing a restricted-access dataset of all opioid-related deaths between 2005 and 2017, I find no empirical evidence to support the contention that relaxing scope-of-practice laws endangers patient safety. Instead, I find consistent and statistically significant evidence that eliminating scope-of-practice restrictions reduces opioid-related deaths by between 5 and 11 percent. These results demonstrate that, had all states allowed nurse practitioners to practice independently, five thousand fewer people would have died of an opioid overdose in 2018 alone. This evidence supports (1) making the temporary relaxations of scope-of-practice laws permanent and (2) expanding these relaxations to other states that have always maintained restrictive laws. Not only will removing legal barriers to the provision of care ameliorate the effects of the current pandemic, but also it will address many of the pervasive problems that predate, and will postdate, COVID-19. This Article engages with the results of the empirical analysis to explore several state and federal policy options to relax scope-of-practice laws and meaningfully improve access to care permanently.
Recommended Citation
Benjamin J. McMichael, The Access-to-Care Epidemic, 56 Wake Forest L. Rev. 547 (2021).