Antitrust and the future of nursing: federal competition policy and the scope of practice.
Year: 2014
Type: article
Abstract: Health Matrix•Volume 24•2014Antitrust and the Future of Nursing 146 Planning, Bureau of Economics, and Bureau of Competition 14 have observed that: (1) many geographic areas (or markets) are subject to primary care workforce shortages;(2) market forces may be slow to clear those shortages due to regulatory impediments to competition, among others;(3) such shortages may impinge upon both price and non-price competition between health care service providers; (4) in some places, such shortages may impede patient access to primary care services and may, in the limit, drive the supply of certain services to nil; and (5) scope of practice restrictions on APRNs appear underrationalized (at best), where they purport to rest upon patient protection concerns that are not based on demonstrated patient harms or empirically grounded assessments of substantial patient risks.15 Because restrictions on APRNs' licensure and scope of practice may come at a substantial competitive cost, FTC staff have recommended that such limits not be more stringent than patient protection requires.16 In broad strokes, they have asked that state policymakers account for competitive costs when considering scope of practice restrictions, and they have suggested that certain costs 14.Competition advocacies often are issued jointly by the staffs of the FTC's Office of Policy Planning, Bureau of Economics, and Bureau of Competition.Formally, advocacies may be issued by either the Commission or its staff, although the distinction may sometimes be unclear.Individual Commissioners may review comments differently, depending on the intended signatories, and the Commission may disclaim that staff comments represent the Commission's own views.Still, both Commission and staff advocacy entail the Commission's review of (and editorial input into) analyses researched and drafted by the staff, and neither type of comment is issued without a vote to authorize issuance by the Commission.Advocacy letters commonly note: "This staff letter expresses the views of the Federal Trade Commission's Office of Policy Planning, Bureau of Competition, and Bureau of Economics.The letter does not necessarily represent the views of the Federal Trade Commission or of any individual Commissioner.The Commission, however, has voted to authorize staff to submit these comments."Id. at 6 n.1.15. See generally infra Part II.B.As discussed below, state policy makers might seek to balance, e.g., patient safety concerns with competition concerns, or they might seek to account for service quality (including safety) within a competition analysis.In either case, competitive impact should be considered, and countervailing consumer protection or patient safety concerns ought to be well-founded, rather than speculative or pretextual.See, e.g., infra notes 140, 173 -192 and accompanying text.16.For a summary of these FTC staff recommendations as they apply to APRNs generally, see DANIEL J. GILMAN & TARA ISA KOSLOV, FED.
Source: PubMed
Authors: Daniel J Gilman, Julie Fairman
Language: English
Topic: Nursing Roles and Practices
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3125234279