Scope of Practice Laws

One effect of the expansion of coverage has been predicted to be increased utilization as more people have coverage.  The aging of the population is forecast to have a similar effect.  Concern has been raised about the adequacy of the current health professional workforce to meet this increased demand.  This issue of Health Affairs is largely comprised of articles focusing on this topic.  Two deal with the impact of scope of practice laws.   (HA Article)  (HA Article)   Scope of practice laws, which are generally promulgated at the state level, define what services a particular licensed health professional may render.  Historically, doctors have been the motivating force behind many of these laws as they zealously sought to protect their profession and their incomes, both by outright bans on performance of some services by other provider types or by requiring physician supervision.  Organizations representing other health professionals have become a more effective counterweight to doctor lobbying in recent years, and scope of practice has generally been expanding.  The first article details some of the issues with scope of practice regulation and suggests remedies.  The second article describes more specifically how these laws limit the ability of retail clinics to deliver more types of care, which they do much less expensively than in other settings, such as doctors’ offices.  Examining a commercial health care database, they found that episodes of care that began at a retail clinic were treated at lower overall cost than those starting in other settings and that when a nurse practitioner could practice without physician supervision, the costs were even lower, although these results were not adjusted for patient characteristics.  It is apparent that greater use of retail clinics where a nurse practitioner can practice independently could both expand capacity and reduce costs.  There is no real support in the research literature for restraints on scope of practice based on quality.  And we have long believed that since unit costs are the primary source of health spending growth, allowing less expensive providers to deliver as much health care as possible is an excellent approach to lowering spending.  Patient satisfaction with non-physician care tends to be as high as for that given by doctors.  Since half of all health spending now comes from governments, they should be strongly motivated to remove regulatory barriers to scope of practice.