Provider turf wars and Medicare payment rules

Alice J. Chen, Elizabeth L. Munnich, Stephen T. Parente, Michael R. Richards

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Barriers to entry and scope of work restrictions are common features of US labor markets, especially within healthcare industries. However, concerns over access and costs of care have encouraged some deregulation. We empirically explore relaxed occupational rules of anesthesia care whereby physician-trained anesthesiologists and certified registered nurse anesthetists (CRNAs) perform overlapping services but often engage in joint production. After CRNAs were granted practice independence, we find only modest (3%) reductions in anesthesiologist billing for CRNA supervision and no evidence of greater use of CRNAs. Our results caution policymakers against overestimating the downstream impact resulting from removing these provider regulations.

Original languageEnglish (US)
Article number104812
JournalJournal of Public Economics
StatePublished - Feb 2023

Bibliographical note

Funding Information:
The authors wish to thank Elena Andreyeva, Laura Dague, Sara Markowitz, Carson Schmit, Ben Ukert, Anand Dash, and seminar participants at Cornell University, Texas A&M University, and the University of Nevada-Las Vegas as well as the organizers and participants of the 2020 Junior Health Economics Summit and the 2021 NBER Health Economics Spring meeting for helpful feedback on earlier versions of this work. We also thank the Editor, Jeff Clemens, and three anonymous reviewers for a host of excellent suggestions to improve the paper. Data were made available through Health Systems Innovation HSI Network LLC and accessed by Elizabeth Munnich as an HSI Business Associate. The authors have no conflicts of interest to disclose. All views and errors are their own.

Publisher Copyright:
© 2022 Elsevier B.V.


  • Anesthesia
  • Certified registered nurse anesthetists
  • Medicare
  • Physicians
  • Provider regulation
  • Quality of care
  • Scope of practice


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