Friday, March 06, 2015

Professional Licensure and the Cost of Care

Last February 18, the US Supreme Court in a 6-3 decision ruled that the Federal Trade Commission was allowed to charge the North Carolina State Board of Dental Examiners with “anticompetitive and unfair actions.”  It seems that spas and salons in the state had been offering teeth whitening services, a service that had been shut down by the Board as constituting the practice of dentistry without a license.  The Board is dominated by dentists and Justice Kennedy opined that “Active market participants cannot be allowed to regulate their own markets free from antitrust accountability.”

Professional licensure is among the major barriers to cost reduction in health care.  Adopted for the purpose of protecting the public from charlatans and unqualified providers, they now effectively prevent provider organizations from experimenting with different, more efficient ways of organizing and staffing the delivery of health care services. 

A case in point is the use of nurse practitioners and physician’s assistants to provide primary care.  There is reason to argue that it ought to become standard practice and some of it is happening but the change is proceeding at snail’s pace.

The North Carolina decision does not address that issue, but it reminds us that professional licensure can have consequences other than those initially intended.


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