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Health Econ Rev. 2017 Dec;7(1):10. doi: 10.1186/s13561-017-0146-6. Epub 2017 Feb 28.

Assessing the impact of state "opt-out" policy on access to and costs of surgeries and other procedures requiring anesthesia services.

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Avalon Health Economics, LLC, 26 Washington Street, 3rd Fl, 07960, Morristown, NJ, USA.
Health Policy & Management, Texas A&M University, 212 Adriance Lab Rd, 1266 TAMU, 77843-1266, College Station, TX, USA.
Division of General Internal Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
American Society of Anesthesiologists, 1061 American Lane, 60173-4973, Schaumburg, IL, USA.
Avalon Health Economics, 26 Washington Street, 3rd Fl., 07960, Morristown, NJ, USA.


In 2001, the U.S. government released a rule that allowed states to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist. To date, 17 states have opted out. The majority of the opt-out states cited increased access to anesthesia care as the primary rationale for their decision. In this study, we assess the impact of state opt-out policy on access to and costs of surgeries and other procedures requiring anesthesia services. Our null hypothesis is that opt-out rule adoption had little or no effect on surgery access or costs. We estimate an inpatient model of surgeries and costs and an outpatient model of surgeries. Each model uses data from multiple years of U.S. inpatient hospital discharges and outpatient surgeries. For inpatient cost models, the coefficient of the opt-out variable was consistently positive and also statistically significant in most model specifications. In terms of access to inpatient surgical care, the opt-out rules did not increase or decrease access in opt-out states. The results for the outpatient access models are less consistent, with some model specifications indicating a reduction in access associated with opt-out status, while other model specifications suggesting no discernable change in access. Given the sensitivity of model findings to changes in model specification, the results do not provide support for the belief that opt-out policy improves access to outpatient surgical care, and may even reduce access to outpatient surgical care (among freestanding facilities).

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