This study examines the impact of legalizing fentanyl test strips (FTSs) on drug-related mortality in the United States from 2018 to 2022. Using a difference-in-differences approach with state-level data, we find that FTS legalization is associated with a significant reduction in drug-overdose deaths. Across the population, FTS legalization corresponds to a 7% decrease in overdose mortality, with an even more pronounced 13.5% reduction among Black individuals. Our analysis employs two-way fixed effects models and triple differences specifications to isolate the effect of FTS legalization from other factors. The results suggest that FTS legalization is particularly effective in reducing unintentional drug-overdose deaths. These findings underscore the potential of FTS as a critical harm reduction tool in addressing the opioid crisis, especially in mitigating racial disparities in overdose mortality. The study provides evidence to support expanding access to FTS as part of comprehensive public health strategies.

We explore the labor market effects of state-level scope of practice (SOP) reform for nurse practitioners that grants full practice authority (FPA) on the earnings and labor supply decisions of physicians and nurse practitioners. We employ a difference-in-differences research design using data from the American Community Survey between 2010 and 2019 to find that SOP laws granting FPA increase earnings of nurse practitioners and have some impacts on their labor supply. However, we find no effects on the earnings of physicians. To examine mechanisms, we use aggregated Medicare data from the Dartmouth Atlas to show no change on physician reimbursements.

Background: In the United States, states are increasingly adopting scope of practice reform to allow full practice authority (FPA) for advanced practice registered nurses (APRNs), such as nurse practitioners (NPs) and certified nurse midwives (CNMs). Little is known about the extent and trends of APRN participation in the care of patients during pregnancy episodes (i.e., the period from a woman’s last menstrual period to birth and resolution of all pregnancy-related outcomes) and whether their involvement changes with FPA.Purpose: To examine the participation of APRNs in office-based prenatal care between states that allow APRN FPA and those that do not.Methods: Using a retrospective commercial insurance claims database, we identified continuously enrolled females undergoing a pregnancy test and constructed comprehensive care information of each pregnancy episode. We then identified the proportion of episodes in which at least one prenatal office-based evaluation and management visit was performed by an APRN (i.e., involvement) and the share of these visits within a pregnancy episode performed by APRNs (i.e., intensity of involvement) for each year from 2008 to 2014 and compared intertemporal and geospatial trends. Statistical tests of differences in means and proportions were used to examine differences in APRN involvement and intensity between states that allow APRN FPA and those that do not.Results: Between 2008 and 2014, NP involvement increased 304% and CNM involvement increased 134%. Involvement increased in both FPA (NPs: 267%, CNMs: 106%) and non-FPA (NPs: 307%, CNMs: 156%) states over the sample period. Involvement was higher in FPA states (p < 0.001) for NPs and CNMs in all years. Intensity exhibited little variation across the sample.Conclusion: APRN involvement in care during pregnancy episodes has increased over time, although considerable variation exists between states.

We examine how scope of practice reforms that allow nurse practitioners independent practice authority impact children's health. We exploit spatial and temporal variation in independent practice authority to implement a difference-in-differences research design using data from the first three waves of the National Survey of Children's Health. We find that these reforms have significant positive impacts on a commonly used and validated measure of children's health: parental evaluation of child health. As a result of this scope of practice reforms, parental evaluations of overall child health improve as parents increasingly rate their child as having Excellent Health. More importantly, we observe these improvements in health are driven primarily by older children and children from lower family income backgrounds. These findings indicate that an expansion in the supply of healthcare through occupational licensing reform can positively influence health outcomes for children. Such findings have important implications for mitigating child health inequality.

PURPOSEDiabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers.METHODSThis study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics.FINDINGSNurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties.CONCLUSIONSExpanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

We evaluate the impact of corruption on firm births in the formal sector in the 32 Mexican states. In addition to controlling for socioeconomic factors previously linked to entrepreneurship, we also evaluate the impact of corruption and corruption squared in each of the Mexican states with both spatial and non-spatial models. Our results show that corruption is positively correlated with the formation of new formal-sector firms, but corruption squared is negatively correlated with firm formation. We believe this implies that some corruption helps entrepreneurs navigate complex rules and bureaucracy but too much corruption hinders entrepreneurship. We find a strong spatial component to new firm formation.

How can societies advance social justice? Research on economic freedom addresses many social justice goals, including social tolerance and protection of minority rights, promotion of democracy and political freedoms, and income equality. We survey the academic literature on these topics and find that economic freedom can advance social justice goals in some cases. For income equality the resulted are mixed, but the other goals have a clear relationship with economic freedom. Based on these results, social justice advocates may want to embrace economic freedom to achieve goals such as tolerance, minority rights, democracy, and political freedom.

This paper investigates the decline of state chartered banks in the rural states Alabama, Arkansas, Nebraska, Oklahoma, and Tennessee. We use bank capital as the dependent variable for the mixed model regression analysis. We analyze both state and bank specific variables to determine which factors have more influence on bank equity capital. The findings indicate that as bank equity capital increases, the number of state chartered banks decreases. We also find that small agriculture business loans increase as equity capital increases, showing that in our sample of rural states agriculture is significant in providing a capital buffer for state chartered banks. However, we find that loans secured by farmland do not statistically influence bank equity capital.

OBJECTIVES:Hospital sharing of electronic health record (EHR) diagnostic data has the potential to improve communication across providers and improve patient outcomes. However, implementing EHR systems can be difficult for hospitals. This study uses Hospital Compare (HC) and American Hospital Association (AHA) Annual Information Technology Survey data to estimate the association between sharing EHR data and patient outcomes.STUDY DESIGN:Descriptive and multivariate linear regression analyses.METHODS:This study links 2 years of HC data on 30-day patient mortality and readmissions for heart failure (HF) and pneumonia with 2 years of AHA data. The sample was restricted to hospitals included in both years in both sets of data. We estimated the associations between sharing EHR diagnostic data and patient outcomes with a multivariate linear regression analysis. Results were adjusted by hospital characteristics from the AHA annual survey.RESULTS:Hospitals' sharing of radiology report data with hospitals within their system was associated with significantly lower mortality scores for pneumonia (-0.22; P <.01). Conversely, hospital sharing of radiology report data with hospitals outside their system was associated with significantly higher HF mortality scores (0.26; P <.01). We found qualitatively similar results with sharing laboratory results through EHRs.CONCLUSIONS:Hospital sharing of EHR data with providers within their system is associated with better patient mortality, whereas sharing data with providers outside their system is associated with worsened patient mortality. Improving communication between hospitals using different EHR systems may be more crucial than simply expanding data sharing.

The ratchet effect in public finance refers to the historical phenomena that the size of government increases during a crisis but does not return to its previous level when the crisis ends. The traditional explanation is that voters change their views on the appropriate size of government during the crisis. But change in tasteI is an explanation of last resort: it should not be accepted without examining alternatives. This paper looks Civil War taxes as an illuminating case of the ratchet effect. Both the observed political process and the resulting mix of taxes suggest that interest groups, not voters, led to the ratchet effect in this case. During the CivilWar both tariffs and income taxes increased, but only the higher tariff stayed. This paper uses an analytical narrative to show that this was because the new interest groups only wanted the higher tariff and not the income tax.

During the most recent recession, many state governments faced substantial budget shortfalls.State politicians often blame the fiscal crises created by those shortfalls on factors largely outside their control, such as the declining economy or reductions in federal aid. Others have suggested that what state politicians themselves do, especially during expansionary years?whether they enact rapid spending increases, implement large tax cuts, increase the size of their rainy day funds, or take some combination of these actions?may be an important factor contributing to budget shortfalls during recessions. We examine these competing hypotheses and tend to find a positive relationship between spending growth (both current and lagged) and fiscal stress during recessions and a negative relationship between the size of rainy day funds and fiscal stress. We tend not to find a significant relationship between fiscal stress and either the unemployment rate or federal aid. That lack of a significant relationship supports the idea that politicians have greater control over the fate of the state's finances than they often claim. It also illustrates the importance of spending restraint and rainy day funds as strategies for minimizing fiscal stress.

Ohio’s public pension system comprises five state-level plans that have actuarial funding ratios ranging between 67 and 84 percent. Pension plan funding levels are a proxy for the ability of a pension plan to fund its promised benefit payments without additional resources. Volatile and uncertain investment returns mean that even a fully funded pension plan has less than a 50 percent chance of having sufficient assets to fund all accrued future benefit payments, so the likelihood that Ohio’s pension plans can meet their obligations is even less. In this study, we determine the likelihood that Ohio’s major public pension plans will be able to make their accrued, promised future payments using only each plan’s current stock of assets—without future contributions, which are intended to fund benefits that accrue later. Furthermore, we calculate the amount of assets the pension plans would need to increase the likelihood of being able to fund future benefit payments and the effect this has for potential “overfunding.” Overall, we show that traditional funding ratios may be a misleading indicator of a pension plan’s ability to use current assets to pay future benefits.

Incorporating a political economy approach not only adds another viewpoint to traditional economics, it offers the opportunity to engage in critical thinking about alternative methodologies, and to debate about economic hypotheses and conclusions. Such an approach can potentially make the material more lasting for students by making economics more relevant. Weaving the material into an overall political economy curriculum not only adds an additional layer of learning, but provides scaffolding for higher learning. We provide a rationale as well as many suggestions for courses. Incorporating pluralistic curricula with political economy instead of inserting the ideas into a single course allows economics departments to improve student learning so that it becomes truly meaningful to the student.

J.K Rowling’s series of books about the underage wizard Harry Potter is an exceptionally effective tool for introducing students to the key concepts of public choice. By keeping political figures at the forefront of the story, Rowling encourages students to recognize the differences between the choices made by individuals in markets and politics. To illuminate the pedagogical potential of the series, and to ease its adoption, we discuss a set of examples that best illustrate the key concepts of public choice. We also share a classroom exercise showcasing how the series can be used to promote active learning.

Although a substantial amount of research explores how work units collectively benefit from authority figures who adhere to the rules of justice (i.e., justice climate), virtually no research explores how authority figures themselves benefit from creating a climate of fairness. We draw from relational theories of human behaviour and psychological well‐being to develop a theoretical model of the relationship between justice climate and authority figures' well‐being. Using data from a sample of 1297 employees and 162 authority figures within 162 work units, we find that procedural justice (PJ) and interactional justice (IJ) climate relate to authority figures' occupational satisfaction and emotional exhaustion; IJ climate also relates to positive affect. In addition, in line with an agent‐related justice perspective, IJ climate has a stronger overall impact than PJ climate on authority figures' well‐being.Practitioner points Finding individuals who want to be organizational authority figures is difficult if there are perceived psychological costs associated with being an authority figure. The reported research suggests organizations may want to highlight the positive relationship between adherence to rules of justice and the psychological well‐being of authority figures as a potential benefit of assuming authority positions. Whereas traditional approaches to job design suggest the redesign of significant portions of the job (which is not always practical), our results suggest large‐scale changes may not be the only method for enhancing the positive feelings authority figures have about their job. Organizations could instead emphasize the positive impact that authority figures have on the work group as a whole. Given that working closely with the beneficiaries of one's efforts is intrinsically gratifying, such an emphasis might be enough to help create a more healthy and enjoyable environment for organizational authority figures. Managers should pay particular attention to the interpersonal interactions they have with their employees. Our results suggest it is the interpersonal component of justice climate, as compared to the more process‐ or policy‐oriented components, that is the most beneficial to organizational authority figures.

During the most recent recession, many state governments faced substantial budget shortfalls. Those shortfalls are often blamed on external factors like the declining economy or reductions in federal aid. What politicians themselves do, especially during expansionary yearswhether they enact spending increases, implement tax cuts, increase the size of their rainy day funds, or some combination thereofis typically given less attention. We examine those factors and find that fiscal stress tends to be positively associated with spending growth, negatively associated with the size of rainy day funds, and not statistically significantly associated with the unemployment rate or federal aid.