The Importance of Licensing Health Care Providers

What market failure is the state correcting by requiring the licensing health care providers? Could this be done by the private sector, if so why? Is it done in the private sector today? Compare the advantages of a public regulation system and compare to the advantages of a private regulation system.

This essay discusses the significance of state licensing, compares the quality of services between private and public facilities and draws a conclusion on whether the state is doing a critical role to ensure that concerned facilities operate within the confines of the law to provide high quality services. Licensing healthcare service providers is a means used by the state government to control quality in social care and provision of health care. The accreditation of programs in medical schools, certification or revalidation and the licensing of doctors is thought to be vital in ensuring quality of healthcare service. Whereas regulation in the medical profession is mandatory as stated by the medical regulatory requirements, the process by which doctors across the country maintain their license or become licensed quite vary.

The purpose of the state healthcare license, procedures and policy are to provide and ensure adherence to professionalism and legal requirements in the daily operations of health care service providers and specialists. Through the many years of working with procedures and policies that license outlines, it is evident that license is essential in providing health and safety clarity when dealing with activities and issues that are critical to human health, (Glouberman 74)[1]. In addition, license in healthcare ensures that the set policies are adhered to. Policies such as the “standard of care” are vitally important in the healthcare sector as they set general action plan used to guide the desired outcomes and can still be used as a guideline in making decisions. The aim of procedures and policies is to stipulate to healthcare service providers the foundation for delivery of cost-effective and safe quality care.

Healthcare provision involves the application of highly interpretive skills where health care providers partner with medical language specialists to create a good environment for providing care to patients. Quality healthcare involves proper understanding of the whole diagnostic process, clinical medicine procedures, care, prescriptions and treatment to be accurately applied and interpreted within the context of narrative dictation that is mostly complex and difficult to understand. Dictation-related challenges demand that healthcare specialists should be licensed for them to exhibit competent interpretive skills in the field. Health care service providers cannot acquire the required interpretive skills without a significant foundation of training and knowledge.  

The pace at which the health care is growing provides a space for mentoring or for on-job training under the ACGME regulations. Such unregulated training scenarios bring about dangerous and unpredictable gaps of knowledge that limits the ability of specialists and health care providers to identify inconsistencies and an error in a patient’s dictate narrative and interfere with the interpretive process.  Flagging discrepancies and inconsistencies in the healthcare record is the major role of documentation of healthcare specialist as providers rely on the interpretive mind, ears, and eyes of the workforce to ensure that data captured on health is recorded accurately, inconsistencies are addressed and authentication of the amended record by the provider.

The only way to ensure that health service providers can be trusted with their roles is to hold workforce accountable to a well-defined scope of practice through certification, testing and licensing, (Chassin 1003)[2].

Despite efforts by the state to use licensing of health care providers as a means of ensuring quality, the private health sector delivery is argued to be more accountable, sustainable and effective than the delivery of public sector. Quality of health services in private sector is perceived to be high (Mean: 3.8188) according to the opinion of clients or patients often based on sophisticated equipment and provider’s responsiveness (Irfan and Ijaz 17). For example, according to the Statistical Brief #95, a project on cost and utilization of healthcare, only 25% of public hospitals had hospitalists on staff as compared to 50.3% in private hospitals (Fraze et al. 2). Moreover, the private sector is associated with higher proper patient care and patient-doctor relationship than the public sector.

Both public and private hospitals have their advantages and disadvantages as well. However, the private sector is more accessible to patients. Accessibility here refers to the waiting time of a patient before being attended to. The wait times are found to be longer in the public sector (Mean: 2.4375) as compared to private sector (Mean: 3.3875) (Irfan and Ijaz 16). Also, doctors are found more present in private sectors (Mean: 3.8188) at any time of patient presentation (Irfan and Ijaz 16). Also, patients tend to report better hospitality from private health service providers (Mean: 3.4792) than public facilities (Mean: 2.3583) (Irfan and Ijaz 14). This is based on explanation given on diagnosis, cleanliness of facilities, and availability of medical inputs, capacity building and courtesy of staff. In private sectors patients are seen for longer time which is likely to have their diagnosis explained well to them. The state does a fundamental job of ensuring that all the licensed facilities adhere to the policies, procedures, and processes that pertains to healthcare.

The public sector is also associated with unavailability of drugs and service provision. Most private facilities tend to stock more drugs than the public facilities. Dispensation of unnecessary procedures and medications has also been reported to be higher in the private sector (Basu et al.). The common scenario involves the use of antibiotics for unnecessary treatment of acute respiratory infections and non-complicated diarrheal diseases.

Despite the many challenges faced by public hospitals, adherence to medical standards and accuracy in diagnosis are highly observed than in the private sector. Private sector practitioners tend to have a little knowledge of correct treatment or diagnosis for infectious disease management protocols such as tuberculosis (Yesilada, Figen, and Ebru Direktör 27). [A1] Public providers are likely to use rapid diagnostics and the recommended combination of therapies as compared to private sector, (Relman 951)[3]. Poor adherence to prescription guidelines and practices by the private sector such as sub therapeutic dosing is associated with a high rise in drug resistance. Also, Data on transparency, regulation, and accountability tend to be unavailable in the private sector on outcomes and delivery practices.

Currently, the State only provides a license permitting medical practice or rejects a license barring practice. Should the state do more, such as ranking physician quality? Should the state do less by not requiring a license to practice medicine?

This section elucidates the significance of licensing to ensure practitioners deliver quality services and concludes on whether there are other things which the state can do to improve the state of healthcare.  With the increased interest in quality health care services, the state has been using license as a measure for compliance to standards and application of conditions and concepts to the health care sector. Even with a licensed service provider, there is no clear evidence of quality and expected outcomes which have not been met and the wide variations in standard maintenance of healthcare. Where the quality of health provided needs to be improved, there is the need to recognize and rank the physicians based on their performance appraisals. The process of licensing needs to be based on sound performance records for quality delivery of healthcare service.

            A licensed medical service provider should be able to provide high-quality care consistently based on medical science and technology. Increased know how in health service provider will translate into better quality of medical services which the individuals and population expect rightly, (Yesilada 961)[4]. How the delivery of care is organized is equally important.

Furthermore, towards achieving quality care in health care institutions, physicians should be ranked based on patient feedback and outcomes. With the availability of this information and statistics, patients will be able to choose the best service provider for their specific condition or diagnosis, and at the same time, physicians can choose to have opportunities at top-notch hospitals.

The failure to recognize and rank performing physician leads to underuse or failure to provide adequate health care services to a patient that would have produced the desired outcome for that patient which is a common problem. Additionally, even those who are able to access the health care system still fail to receive the clinically indicated services or the recommended preventive services for both chronic and acute conditions (Goldman and McGlynn). In overall, the difference between the care a patient should receive and what they receive in public health service providers is at large.

Recognition of qualified physicians help to reduce issues that arise from patients’ lack of knowledge. Such issues occur when an appropriate service is provided such as the occurrence of a preventable complication such that the patient does not receive a recommended intervention. However, taking advantage of patients’ lack of knowledge may also refer to medical errors in prescription or issuing of medical dosses.

Licensing has been used exclusively to measure high-quality care for patients; however, monitoring of improvement of quality has not been monitored but has been viewed as an individual responsibility in the private sector. However, it’s evident that inexplicable and wide variations in patterns of practice as well as in interest of the consumers should be considered. With the increased costs of services in both private and public sectors, the state should push for accountability of the services provided through patient feedback.

The state should not use a license only as a tool for quality measure but also include other relatively stable elements. This refers to dimensions of quality such as the effect of care on the health status of both the population and the patient. It includes the outcome of efforts to diagnose, prevent and treat health conditions and is often viewed as a patient’s bottom line of quality assessment on health care. In general, the definition of good structures includes, the availability of good process increases the likelihood of the desired outcomes.

The measurement of quality of healthcare is made up of unusually diverse components from the patient handling and prescription. Additionally, access to quality care is another concern for patients as they may be unable to explain the causes of their conditions hence this calls for a more experienced physician. Physician’s friendliness towards patients is a good measure of the quality of a healthcare service.    

Generally, there’s notable dissatisfaction with the current health care systems from the consumer which is an indicator of less optimal quality. Although most patients may not be medical experts, previous studies have shown that patients tend to report many experiences including lack of adequate clinical care with the current health care services, (Camilleri 128)[5]. A patient’s satisfaction feedback will provide meaningful assessment of the management and design of the health care services.

Furthermore, patient experiences are important feedback given that the patient-doctor interpersonal relationship is vital in evaluating the quality of technical health care delivered. Most patients who have been dissatisfied with health services delivered have been found to change physicians from time to time thereby disrupting health care continuity and delaying provision of care needed hence leading to low health outcomes. For all the reasons discussed, patient satisfaction and feedback should be a valuable measure as well as optimal ratings of physicians for healthcare service providers in both private and public sector.

Works Cited

Basu, Sanjay et al. ”Comparative Performance of Private and Public Healthcare Systems in Low- And Middle-Income Countries: A Systematic Review.” PLoS Medicine 9.6 (2012): e1001244. Web.

Camilleri, David, and Mark O’Callaghan. ”Comparing public and private hospital care service quality.” International Journal of Health Care Quality Assurance 11.4 (1998): 127-133.

Chassin, Mark R., and Robert W. Galvin. ”The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality.” Jama 280.11 (1998): 1000-1005.

Fraze, Taressa et al. Statistical Brief #95: Public Hospitals in the United States, 2008. Agency    for Healthcare Research Quality, 2010. Print.

Goldman, Dana P., and Elizabeth A. McGlynn. Health. RAND, 2005. Web. 19 Mar. 2018.

Glouberman, Sholom, and Henry Mintzberg. ”Managing the care of health and the cure of disease—Part II: Integration.” Health care management review 26.1 (2001): 70-84.

Irfan, S. M., and A. Ijaz. ”Comparison of Service Quality between Private and Public Hospitals: Empirical Evidences from Pakistan.” Journal of Quality and Technology Management 7.1 (2011): 1-22. Print.

Relman, Arnold S. ”The new medical-industrial complex.” New England Journal of Medicine 303.17 (1980): 963-970.

Yesilada, Figen, and Ebru Direktör. ”Health care service quality: A comparison of public and private hospitals.” African Journal of business management 4.6 (2010): 962.

[1]

Glouberman, Sholom, and Henry Mintzberg. ”Managing the care of health and the cure of disease—Part II: Integration.“ Health care management review 26.1 (2001): 70-84.

[2]

Chassin, Mark R., and Robert W. Galvin. ”The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality.” Jama 280.11 (1998): 1000-1005.

[3]

Relman, Arnold S. ”The new medical-industrial complex.” New England Journal of Medicine 303.17 (1980): 963-970.

[4]

Yesilada, Figen, and Ebru Direktör. ”Health care service quality: A comparison of public and private hospitals.” African Journal of business management 4.6 (2010): 962.

[5]

Camilleri, David, and Mark O’Callaghan. ”Comparing public and private hospital care service quality.” International Journal of Health Care Quality Assurance 11.4 (1998): 127-133.

[A1]Provide evidence for this claim.