Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Health Administration
First Advisor
Adam Atherly
Second Advisor
Saleema A. Karim
Third Advisor
Laura McClelland
Fourth Advisor
Faika Zanjani
Abstract
Problem statement and research objective: The United States has had a long-standing shortage of primary care providers (PCPs), which has created significant barriers to accessing care among the population aged 65 years and older. One proposed solution is to extend full practice authority (FPA) to Nurse Practitioners (NPs) to allow them to practice independently. Previous research has found inconsistent effects of FPA for NPs on access to care among the population aged 65 years and older. In this study, I estimate the effect of extending FPA to NPs on access to care among Medicare beneficiaries.
Methods and procedure: I compared access among Medicare beneficiaries in states that extended FPA to NPs to those in non-FPA states. I used a quasi-experimental difference-in-differences analysis of longitudinal data from the Medicare Current Beneficiary Survey (MCBS) from 2006 to 2019. The MCBS surveys a nationally representative sample of Medicare beneficiaries 65 years and older. Access to care is measured by driving times to usual primary care, appointment wait times for primary care, in-office wait times for primary care, preventable hospitalizations, and diabetes management.
Findings: The analysis found that driving times to usual primary care decreased by 6.2% after states extended FPA to NPs. Medication adherence for diabetics increased by 17 percentage points after states extended FPA to NPs. After Colorado and Nevada extended FPA to NPs, the probability of preventable hospitalizations decreased by 6 and 2 percentage points, respectively.
Conclusions: Extending FPA to NPs can lead to improved access to care for Medicare beneficiaries, which in turn may translate into better chronic illness management.
Rights
© Yanyan Shen
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-8-2026