CATO HAND BOOK FOR REGULATORS: …Licensing allows physicians to restrict entry into their profession and to restrict the supply of substitutes for their services. By lobbying legislatures to restrict the scopes of practice of nurse practitioners and physician assistants, physicians can reserve certain tasks for themselves. Such restrictions increase the demand for physician services and increase physician incomes. They also make medical care more expensive and reduce access…
Licensing also enables midlevel clinicians to do the same. Nurse practitioners, for instance, can restrict entry into their profession (and thereby increase their incomes) by pushing states to increase the education requirements for a nurse practitioner’s license. They can block competition from substitutes for their services by lobbying to restrict the scopes of practice of other nonphysician clinicians…
A more dynamic analysis further suggests that licensing may in fact lead to worse health outcomes. Prepaid group practices such as Kaiser Permanente and Group Health Cooperative combine an integrated delivery system with prepayment. These plans make greater use of midlevel clinicians, preventive and primary care, and electronic medical records than other types of insurance or delivery systems. As a result, they have shown remarkable success at increasing the delivery of high-quality services, reducing low-value and harmful services (including medical errors), and making health insurance more affordable. As noted earlier, however, physicians have used licensing to block competition from integrated delivery systems and prepaid health plans, in large part because prepaid group practices are generally less remunerative for physicians and restrict physician autonomy. Thus, licensing may be reducing the overall quality of care by inhibiting higher-quality forms of health care delivery… (more)
EDITOR: Conservative CATO institude lauds Kaiser Permanente and Group Health Cooperative, the very model for ObamaCare.
