Twilight of the Medieval Guilds? Scope of Practice Laws Examined

The California HealthCare Foundation, hardly a bunch of right-wing fanatics like us at PRI, has published a sober, but assertive, analysis of how California regulates the scope of practice of health professionals, along with recommendations for improvement. It’s written by scholars at the University of California, San Francisco’s Center for the Health Professions (also not a bunch of fire-breathing opponents of government-run health care), who recently completed a study comparing California’s regulations with a number of other states as well as the Canadian province of Ontario.

(For the right-wing fanatic, a.k.a consumer-driven, viewpoint, please see the U.S. Index of Health Ownership, which has a 5 measurements of scope of practice regulation, or Professor Shirley Svorny’s chapter in What States Can Do to Reform Health Care: A Free-Market Primer.)

Like any independent person who looks at these scope of practice regs, the CHCF and UCSF scholars recommend increased transparency, frequent reviews of the scope of practice regs, and steps to minimise the influence of the regulated professions’ capturing the regulations in order to serve their own interests. Good luck!

But seriously, it’s great to see these establishment-authorities urge improvement to the regulation of the health professions, which too often resemble medieval guilds, instead of practitioners of 21st century science.

Recommendations (based on successes in other states and Ontario) include:

  • Regular reviews by a scope of practice review commission;
  • Eliminating conflict of interest, by disallowing Board X from regulating profession Y (like dentists and dental hygienists); and
  • National uniformity, through inter-state compacts and/or national “model practice acts” that all states can independently implement (especially important in cases where health professionals cross state lines to volunteer to assist in natural emergencies).

Pretty moderate stuff overall, I suppose, and hardly likely to move the needle of an arch-libertarian like my friend over at the Cato Institute, Michael Cannon.

Nevertheless, it excites me to see centrist scholars veer away from the obsession with “covering the uninsured”, even for a brief, shining, moment, and give us “do-able” ideas for de-regulating the health professions, which are the biggest cost-driver in U.S. health care.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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