Health professions regulation in the United States

Abstract

The regulation of health professions in the United States is a primary responsibility of states. The structure and content of the specific regulations of each state impact the provision of health services, affecting costs, quality and access. There is concern that current state-based and profession-specific regulatory structures cannot serve as a basis for the innovations the health workforce needs for health reform. This paper reviews aspects of state-based health professions regulations that limit the effective use of health workers and also one of its key advantages: their ability to provide local solutions to address access problems. The paper describes elements that generate changes in the demand for health services and health care providers. Finally, strategies are recommended to improve decision-making related to practice including: standardization of practice scopes between different states; permanent updating of specific acts of professional practice in each state, in accordance with the evolution of professional competencies; use of the best evidence to authorize new professions or expand the scope of practice of the existing ones and, when this evidence does not exist, to promote programs to test new modalities of work. Taking into account the pace of changes in the health system in the United States, there is a growing urgency for reforms to ensure adequate size and training of the workforce for the future.