Sunday, February 18, 2007

Medical Licensing: Quackery, Financing, and Mixed Market Economics - Part IV: Private Quality Control

So here it is, the big finale.

As we've already discussed, the current licensing system in medicine creates all sorts of market distortions, limits access to care, and in many cases hurts the legitimate practicioners of medicine in favor of the snake oil salesman. The nagging question, which I know that you are all dying to know the answer to, is "how will we control the quality of medical practice?" This is a rather complex question, with a rather simple solution. The answer is that we should not try and control it at all in classic public police sense. What we should do is open up avenues of information.

Consumer Reports is a popular magazine that features all sorts of quality indicators regarding products in the marketplace. For a very modest sum, any American can gain access to this invaluable information. I can read consumer reports, make my own assesments of accuracy, and make my own cost-benefit analysis. If I'm still not satisfied, I can go to hundreds of different consumer web sites and find out more information. There is essentially no reason why a similar system couldn't be created in medicine.

High level medical practicioners had a basic monopoly in healthcare practice for many years. This didn't hurt many people, because they often cared for those that fell below their fees at a reduced rate. People felt no real reason to try and contain costs. Now however, all sorts of alternative practicioners have already entered the market. They've just done so with varying amounts of training and licensing requirements of their own. In an era of multi-level medical practice, we should question to what degree the license should be required at all.

On another level, the strict licensing system in the US probably gives people false hope in the quality of the care they receive. In the era of a purely physician run healthcare model this may have had SOME merit. Now however, many people treat all medical licenses, when receiving treatment, as though they came from an MD. Many people do not know the difference between providers, and the trust that we are conditioned to put into our physicians has been extended to all sorts of licensed and unlicensed medical practicioners.

I believe in physician training, and I don't believe that it is going anywhere soon. Current certification requirements in practice have already come into existance essentially out of the private market, with insurance companies and hospitals refusing to hire physicians to perform tasks for which they are not residency trained. One could argue that this level of quality control has essentially overshadowed the need for government meddling. With good quality indicators in place, determined preferably by people who actually work in healthcare, we will be able to evaluate the quality of work done at a center. This is a far better system for a patient than purely using the number of letters after a name. Let the centers compete for the letters in order to improve their quality. Informed individuals will then be able to balance quality versus cost in a private system. This is better than some medicare beauracrat determining some kind of "quality control indicator," for "licensed providers," in order to determine "efficient use of public resources."

In conclusion, many alternative practicioners already exist in medicine. The medical licensing system now does not keep out quacks and snake oil salesmen. Modern medical licensing also gives licenses to individuals with all sorts of variation in training as well. This system is progressively hurting the qualified practicioners in the name of those who are less qualified because of its requirements. With the abolition of specific licensing procedures, private sources of information could step in to fill the void in quality control. Rather than mandating a specific quality, information could be used in order to allow the individual to perform his own assesment of the cost and benefit of a medical treatment or provider. Some of this quality control already exists on top of the government licensing, though it disproportionately impacts legitimate practioners. By removing the government and politics from quality control, the market will be free to determine the amount of control necessary to impart quality healthcare.


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2:34 PM  
Anonymous Anonymous said...

Hey... I'm a fellow medical student (first year) and I just came across you blog and am amazed... you not only write well, but your knowledge and ideas are seriously enlightening... I'll be the first to admit I have NO clue what the future, or even the current state of Healthcare is. I've spent essentially my entire life trying to get INTO med school that until now, I never bothered to find out what exactly lies ahead of me. Stupid, but better late than never. I can't comment in the real sense because I have no insight to offer really... but keep writing because people like myself really benefit from your ideas and knowledge... and honestly, cheesy as it sounds, I'm spurred to go and find out more... any sources you recommend? (Aside from heavy books... just to get an initial grasp of healthcare... i.e. the proposed trend towards Universal Healthcare...)... After I learn more, I'd like to start a blog myself... perhaps as an intro to med students about what's ahead... tuition, loans, blah blah aside... IGNORANCE is what is expensive...

12:03 AM  
Blogger Med said...

nice blog on medical economics...

3:37 PM  
Blogger MiamiMed said...

Hey Anonymous,

There is some really good information available through:

This is of course written from a more libertarian perspective. They'll send you what they call a "Medical Student Self Defense Kit," with a lot of different material on medicine, economics, and socialism. On top of that, keep your eyes and ears open. Question what people tell you. The fact that you are in medical school proves that you are smart. Use your logic. Read the paper. Does this make sense? Read my next upcoming post on organ transplantation as an example of critical analysis of an emotional topic. Best of luck.

2:19 PM  

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