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How Regulation Influences Health Policy

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Healthcare providers deal with more regulation than professionals in just about any other industry. What are the effects of that regulatory system? Does the heavy-handed approach to medical regulation serve to increase the quality of care to patients, or to expand access to healthcare for people across the country? Below, we review the effects of regulation on the healthcare industry based on several important measures of success. Call an experienced California healthcare regulatory compliance lawyer with any questions or for help with a matter of healthcare law.

Physician and Patient Autonomy

The government sees one problem and passes 15 laws and regulations to address it. While sometimes noble at heart, the government is not always the best arbiter of what should happen in the medical community. In many instances, in fact, state and federal governments will have warring views on what physicians and other medical professionals should be allowed to do. A state government might decide that nurse practitioners should be allowed to prescribe controlled substances, or that controlled substances should be prescribable via telemedicine, while federal agencies might decide that that poses too great a risk and should be stopped.

When the government over-regulates, as is often the case in the healthcare space, physicians lose their autonomy. While agency officials may believe they are acting to prevent harm to the public, the effect is often to force physicians to recommend treatments (or fail to recommend a course of treatment) that are not in their patients’ best interests. When physicians are forced to go against their professional judgment because of over-regulation, the physician-patient relationship is tarnished.

Health Care Costs

Heavy regulation leads to increased costs for medical care providers. Increased costs for providers mean increased costs for patients, and increased reliance on health insurance providers–increasing costs yet again. Government regulators profess a desire to reduce costs to patients, but they tend to create more inefficiencies and barriers that serve to bloat costs for all parties. Inefficient reimbursement systems in Medicaid and other programs often exacerbate this problem by creating a marketplace for fraud and abuse, leaving legitimate physicians with no option but to increase pricing to offset the damage done to their practices.

Access to Healthcare

Regulation can cut both ways when it comes to healthcare access. Setting unnecessary barriers to entry into the health profession–including onerous insurance costs, myriad regulatory check-ins, competing state and federal agency regulatory schemes, and inefficiencies in the medical marketplace–work to reduce access and increase the cost of healthcare overall. Driving people away from the profession reduces healthcare access for all people.

Reducing regulation, or passing laws and rules that serve to reduce costs and encourage members of the profession to follow their own judgment, can increase healthcare access. For example, during the novel coronavirus pandemic, state and federal governments acquiesced to medical professionals claiming that telehealth could be just as effective as in-person care. Although reticent at first, state medical boards and federal regulators agreed to relax in-person care requirements in light of the national emergency. The result was unprecedented growth in access to healthcare for patients around the country, especially in rural and underserved areas. There was no attendant reduction in the quality of healthcare.

Healthcare Quality

Federal and state regulators are pursuing the elusive goal of increasing the quality of healthcare. The very definition of “quality” in the healthcare sphere, however, is often misunderstood, or the subject of debate. Is quality defined relative to current practices and the current state of knowledge, by the “best” known practices even when they are not the prevailing practices, or by a focus on innovation and new practices?

Moreover, with pricing problems inherent in Medicaid and other systems, physicians are disincentivized to spend the time necessary to provide the best care by any measure. New physicians are encouraged to go into more lucrative fields in specialty care rather than standard preventative care or primary care, leaving a skeleton crew to handle everyday diagnoses and treatments. Over-regulation and inefficient markets discourage innovation, incentivize careful behavior that serves to protect the medical care provider more than help the patient, push new care providers away from the fields that desperately need more hands, and reduce the quality of care overall.

Call a Knowledgeable Healthcare Law and License Defense Attorney to Protect Your California Medical Practice

For help building your medical practice, advice when responding to kickback allegations or regulatory compliance issues, or assistance with internal investigations, auditing, employment matters, governance issues, business disputes, licensing, or any other California healthcare law matter, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.

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