Institutional licensure versus individual licensure.
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ADA policies on licensure encourage states to ease mobility restrictions while maintaining sufficient control to ensure that only qualified individuals provide dental treatment within the state. Many states have had provision to license by credentials for a long time. Licensure by credentials is rapidly replacing reciprocity as an alternate form of licensure. Only four states still participate in what can be termed purely reciprocal licensure agreements. In contrast, 21 states currently offer licensure by credentials. Another trend in licensure in recent years has been increased state participation in regional clinical examination services. Today, 32 states participate in four regional clinical examination services. With the increasing number of states offering licensure by credentials and participating in regional boards, the prospect for increased mobility for dentists appears good.
Economic theories suggest that the introduction of regulation can be analyzed in terms of the magnitude and distribution of its economic impact. This article uses this approach to consider the introduction of licensure in the health sector for clinical laboratory personnel. At the micro level, there is no evidence of active consumer support for licensure and it seems to have been introduced mainly at the behest of members of the occupation and bureaucrats involved in the regulation of laboratories. Bureaucrats appear to have acted largely on their own initiative and are the single most important group involved in the introduction of licensure. The large role of the occupation supports a "producer protection" model of licensure over a "consumer protection" model. But the independent role of bureaucrats suggests that actors in the public sector are also a major interest group who need to be included in any model of regulation. Their motives are complex, but in the past one of the attractions of licensure seems to have been low direct administrative costs, despite large indirect costs to consumers. At the macro level, recent changes in social policy, which may reflect broad class interests, have shifted these indirect costs increasingly to the public sector through programs like Medicare. These changes in the distribution of costs may explain a growing concern by bureaucrats about the efficiency of licensure and a shift away from this type of regulation.
This paper develops a model of the economic impact of occupational licensure. The model is then used to estimate the effects of occupational licensure on wages and the division of labor in clinical laboratories and to generate a low-bound estimate of the welfare impact of licensure. Estimates are based on cross-section and time-series data on areas with and without licensure of laboratory personnel. Recent licensure laws have no effect on wages or employment, but older, more stringent laws sharply increase the wages and employment of skilled personnel in laboratories.
A 1975 survey to determine the impact of state licensure on radiologic technology compared three licensure states with three states that had no laws regulating operators of radiographic equipment. The survey showed no significant differences in radiation protection practices, recruitment, availability, or economic status of technologists. However, school regulations in the licensure states did show a positive effect upon the quality of radiologic technology education.
A questionnaire was sent to every American dental school and each state and regional testing agency, requesting information on the teaching of basic cardiopulmonary resuscitation (BCPR) and its inclusion in the requirements for state dental licensure. The data indicates that 81 percent of the schools teach a course in BCPR and the remaining 19 percent may do so in the future. Presently, 5 states require certification in BCPR for licensure and 17 states indicated they will require BCPR certification shortly.
Today, one out of five practicing physicians in the U.S. is a graduate of a foreign medical school. The sixfold growth in their number over the past two decades results from national policy; but the place and conditions of practice have been controlled by state governments. The several states have used their jurisdiction over licensure in ways that have often been unfair and irrational. Recent trends toward uniform standards, however, may lead to more equitable assurance of professional competence, and to interstate mobility related to local and national needs.
In the continuing debate over licensure for radiologic technologists, more concern needs to be directed toward the patient as the unwary consumer. Radiology patients can only presume that maximum effort is being taken to minimize x-ray exposure. Unfortunately, the patient has little control in guaranteeing that premise.
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