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A Comparison of the Regulation of Health Professional Boundaries across OECD Countries


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  • Ivy Lynn Bourgeault
  • Michel Grignon


Increased attention has been paid recently to the issue of the regulation of professional boundaries. In this paper, we undertake an international comparison of the regulation of health professional boundaries across the OECD countries of Canada, the U.S., the U.K. and Australia. Our case studies focus on the inter-professional boundary negotiation between medicine and nursing and the intra-professional boundary negotiation between domestic and internationally trained physicians. Our analysis draws upon the complementary interdisciplinary theoretical perspectives of institutional economics and the concept of professional closure from the sociology of professions. In applying these lenses to the two case studies in these four country contexts, we reveal that there has been a shift in the context of professional regulation towards a more coordinated national approach to licensure. There has also been a broad scale move towards breaking down at least the regulatory barriers to inter-professional collaboration between physicians and nurses which has included the expansion of the scope of nursing practice to take up traditionally exclusive domains of medicine. The seemingly protectionist professional regulatory policies vis-a-vis international medical graduates also seem to be breaking down primarily through government measures. Overall, there has been an increased permeability of professional boundaries both inter-professionally and intra-professionally, and market-oriented systems seem to be in a better position to overcome medical dominance than state-led ones, even though they do not change the main rules of regulation at the macro-level.

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Bibliographic Info

Article provided by Cattaneo University (LIUC) in its journal The European Journal of Comparative Economics.

Volume (Year): 10 (2013)
Issue (Month): 2 (August)
Pages: 199-223

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Handle: RePEc:liu:liucej:v:10:y:2013:i:2:p:199-223

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Keywords: health professional regulation; inter-professional care; international medical graduates; Canada; the U.S.; the U.K.; Australia;

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  1. Mark Pauly, 1980. "Doctors and Their Workshops: Economic Models of Physician Behavior," NBER Books, National Bureau of Economic Research, Inc, number paul80-1, June.
  2. Milton Friedman & Simon Kuznets, 1954. "Income from Independent Professional Practice," NBER Books, National Bureau of Economic Research, Inc, number frie54-1, June.
  3. Mark Pauly, 1980. "Appendix to "Doctors and Their Workshops: Economic Models of Physician Behavior"," NBER Chapters, in: Doctors and Their Workshops: Economic Models of Physician Behavior, pages 119-122 National Bureau of Economic Research, Inc.
  4. Philippe Choné & Michel Grignon & Ronan Mahieu, 2001. "Quelles fonctions économiques pour des opérateurs de soins dans le système de santé français ?," Revue Française d'Économie, Programme National Persée, vol. 16(1), pages 169-214.
  5. Darby, Michael R & Karni, Edi, 1973. "Free Competition and the Optimal Amount of Fraud," Journal of Law and Economics, University of Chicago Press, vol. 16(1), pages 67-88, April.
  6. Pauly, Mark V & Redisch, Michael, 1973. "The Not-For-Profit Hospital as a Physicians' Cooperative," American Economic Review, American Economic Association, vol. 63(1), pages 87-99, March.
  7. Coburn, David, 1993. "State authority, medical dominance, and trends in the regulation of the health professions: The Ontario case," Social Science & Medicine, Elsevier, vol. 37(2), pages 129-138, July.
  8. Kleiner, Morris M & Kudrle, Robert T, 2000. "Does Regulation Affect Economic Outcomes? The Case of Dentistry," Journal of Law and Economics, University of Chicago Press, vol. 43(2), pages 547-82, October.
  9. Akerlof, George A, 1970. "The Market for 'Lemons': Quality Uncertainty and the Market Mechanism," The Quarterly Journal of Economics, MIT Press, vol. 84(3), pages 488-500, August.
  10. Leffler, Keith B, 1978. "Physician Licensure: Competition and Monopoly in American Medicine," Journal of Law and Economics, University of Chicago Press, vol. 21(1), pages 165-86, April.
  11. Grignon, Michel & Owusu, Yaw & Sweetman, Arthur, 2012. "The International Migration of Health Professionals," IZA Discussion Papers 6517, Institute for the Study of Labor (IZA).
  12. Coburn, David, 1993. "State authority, medical dominance, and trends in the regulation of the health professions: The Ontario case," Social Science & Medicine, Elsevier, vol. 37(7), pages 841-850, October.
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