The ‘State’ of Health Care
How much flexibility and discretion are patients, providers, and healthcare entrepreneurs given in your state?
The Healthcare Openness and Access Project (HOAP), a new report co-authored by Dartmouth Institute research project manager Jared Rhoads, provides a state-by-state look at regulatory openness across the country. In the report, Rhoads and his co-authors utilize a scoring system to rank the degree to which state regulations allow or restrict people from seeking or providing care. Sponsored by the Mercatus Center at George Mason University, the concept for HOAP evolved out of Rhoads’ internship project while a student in the Institute’s Master of Public Health program last year. Below he discusses what the HOAP report measures and how it could be used at the policy level to improve health care.
Q: What policy measures does HOAP analyze?
A: Essentially, we’ve created a simplified inventory of each state’s healthcare-related regulations, and assigned scores to make it easy to compare states to one another. We gathered information on 38 individual measures, which we grouped into 10 categories. A measure in our “Public Health” category, for example, is whether states allow easy access to opioid overdose rescue drug naloxone. In some states, you can acquire it relatively easily at a pharmacy and you do not need a prescription. In other states, access to the drug is much more regulated. In our view, this is an area in which less regulation is better, so states that don’t have restrictions in place receive a higher score for this particular measure. Another measure we look at is nurse practitioner scope of access. States have significant power to define what a nurse practitioner can and cannot do, and how much oversight is required by physicians. Our take is that the more that states allows a nurse practitioner to manage, the better for openness and access to health care, so we “scored” the states accordingly.
Q: What are you hoping people take away from the report?
A: What we’re really trying to do with this report is provide a useful tool that state policymakers can use to see how their states fare when viewed on a spectrum of openness versus restrictiveness, and give people ideas on where they can focus their legislative efforts. We’re not trying to have the final word on anything, and we’re not claiming that we’ve managed to measure openness in a fully scientific way. The point of doing an index like this is to start conversations and spark further analysis. To that end, we’ve made all the scores easily downloadable. Others can use this data as a jumping off point for their own research, or they can take these rankings and see if they correlate with health outcomes.
Q: What was your inspiration for this project?
A: As a Dartmouth Institute MPH student last year, I wanted to focus my internship project on policy work. Knowing that a lot of data exists on state policy regulations, I hadn’t yet seen anything that compiled a complete index of how regulated states actually are in their health care policies. I proposed this concept to Mercatus, where I was doing some fellowship work. They really liked the idea and we formed a team to work on the project. The project spanned longer than just the internship, but I stayed on to finish it, and it was published in December.
Q: What has the response to the report been like since it was published?
A: We’ve been getting a great response to it on social media, in podcasts, and in other media coverage. I’ve also been presenting the report at health policy conferences in Washington, DC, and San Diego. What I enjoy most about speaking at these conferences are the suggestions and ideas we receive on how to improve HOAP for next year. We’re already thinking about how we could expand the index to include measures on dentistry and urgent care centers. The goal is to publish updated reports each year to keep pace with laws and regulation changes and to ensure the metrics we provide are relevant.