The healthcare sector of the United States of America USA is tightly regulated by a set of rules and regulations that are exercised by both the federal and the state governments. The laws are intended to create compliance of healthcare professionals and owners of private facilities to the underlying medical ethical principles. Majority of the rules revolve around the four ethical practices of medicine namely autonomy, beneficence, justice, and non-maleficence. These laws have been enacted from the past, and there are different changes made to the original proposals. Still, more future alterations and challenges to these laws are expected. It is therefore essential to consider the past, the current, and the future of the state and federal laws concerning healthcare.

Licensing of Facilities and Practitioners

Laws enacted by both the federal and the state government stem from basic guiding principles namely increased coverage, affordability, accessibility, quality of care and accountability. These considerations are crucial to formulating new policies and amending the existing regulations. The federal government has delegated the licensing of facilities to the state governments. The states provide licenses to in-patient healthcare facilities such as ambulatory surgical facilities, and nursing homes. Besides, the state governments approve the budget, engineering, and building of such facilities. This is under Article Ten of the constitution. The article gives the state administrations, the mandate to regulate the operation of all healthcare facilities within the country. For example, the state of Minnesota approves the construction of new nursing homes within the state on an annual basis (Baker, 2015). However, not all powers on licensing of facilities have been delegated to state governments. The federal law regulates the type of health care facilities that operate within the country. The federal law ensures that the WHO regulations of facilities licensure are strictly followed.

Historically, the federal government mandated the operation of healthcare facilities within the country. In 1946, the Hospital Survey and Construction Act was enacted, and the law was strict on ensuring that construction of any facility met the minimum standards of operations (Baker, 2015). The state governments had the role of monitoring and reporting to the national government. Later, all states opted for direct powers to license and monitor the establishment of facilities within the nation. As a result, in 1950, there were significant amendments in the constitution, and the state regimes were allowed to license the establishment of healthcare facilities.

State governments conduct the current licensing of medical practitioners. There are differences on the requirement of getting a license to practice within the states. Despite the differences, all practitioners have to pass the medical licensing examination. Individual states administer the examination. In the past, the federal government ensures the licensing of medical practitioners and this was possible through the formation of the Federal of State Medical Board, which was mandated with licensing medical practitioners. For example, the early 1920s, the state governments started their individual licensing exam with the state of Missouri being the first one (BHIMJI & SHARMA, 2018).

Future changes on licensing of facilities and practitioners may include strict laws to curb illegal practice of medicine. For strict rules to take root, there is a need for the state governments to create a particular department that is mandated to certify premises and practitioners separately. However, this strict move and the current situation might face some challenges such as immigration and international doctors whose licensure might be difficult. Moreover, an influx of many people might make the field of healthcare provision a nuisance.

Credentialing requirements

Credentialing refers to the process of assessing the legitimacy and background of medical professionals to establish their qualifications for licensing and practice of medicine. The National Committee for Quality Assurance (NCQA) is mandated to conduct credentialing of medical professionals in the USA (Fred, 2016). The committee has set standards that all health care providers have to meet before being licensed. Of the May standards, the primary action of NCQA is to check with the sources of the degree or certificates so that their credibility is certified.

Credentialing in the USA traces back to 1990 when the federal government launched the National Practitioners Data Bank to track all the record of medical professionals. This move was as a result of many malpractice cases. For example, Michael Swango, MD, who had a controversial career (Alkhateeb, Shields, Broedel-Zaugg, Bryan, & Snell, 2011). Many of his patients died or had severe medical complications. Besides, he had been accused with the felony of poisoning his workmates as a resident doctor. Several court cases surrounded the incidence of Michael Swango before he was sentenced to jail. However, the court also ruled that the NCQA to be established to monitor the practice of medicine with the nation. The federal government funds the committee; however, small sections also exist within the states.

The future of credentialing might embrace the registration and follow-up of all medical students until they are registered practitioners and this will ease the process of monitoring the quality of care and prevent altering of academic credentials. Besides, the use of electronic implant chips on all medical professional can track their records and minimize fraud. However, these predicted measures might result in poor compliance and follow-up of medical practice.

Organizational liability

Organizational liability is defined as the acceptance of responsibility by healthcare facilities for any medical malpractice instead of a doctor or healthcare profession. In case of misconduct, the organization is sued on behalf of the practitioner. The current law on organizational liability allows the judge to view any case presented before the court beyond a medical practitioner’s scope of work (KASS & ROSE, 2016). The working conditions and the corporate authority are considered in determining the case. The legal theory of ostensible agency ensures that an organization takes liability on behalf of the practitioner.

However, in the historical model, physicians were independent of the organization in their practice. They were viewed as separate entities in their roles in the hospitals. There was no clear employee-employer relationship. Therefore, the liability of a professional would not be passed on to the organization. For example, in the case; SESSIONS v. THOMAS DEE MEMORIAL HOSPITAL ASSOCIATION, it was argued out by the judges that there was no logic in letting the whole organization suffer due to a mistake by an individual. Individuals had a legal obligation to file complaints against doctors. In 1954, the Kansas court, in the case of NOEL v. MENNINGER FOUNDATION, ruled out in favor of Noel (Bal & Bal, 2013). The judges’ bar agreed that organizational standards had an impact on the productivity of a medical profession.

In future, organizational liability will be intensified. More contacts will be created between the employer and the employee. This relationship will bind any medical professional to the organization. Therefore, organizations will be liable for any malpractice incurred by a doctor. Although this will improve the quality of management by organizations, it might present the challenge of physician negligence as practitioners will feel covered by an organization.

Conflict of interest

Apart from providing healthcare, medical professionals engage in other activities such as teaching, conducting research, and investments in other business opportunities. Some of the medical professionals invest in drug companies or own private clinics. These activities are not related to the daily practice of medicine. As a result, these activities create relationships with other people, organizations, and businesses. Although the underlying motive of these doctors is to provide healthcare, they might benefit financially from these relationships. Therefore, conflict of interest arises when a medical professional’s ability to deliver to the patient is affected by other associations or organizations.

In the USA, the federal government has imposed laws that deal with conflict of interest. In 2003, the government implemented the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) (Easley, 2017). The bill was required to educate patients on their privacy rights, authorization of patient’s medical information, secure patient information, and eventually minimize conflict of interest. Earlier in 1995, the National Institute of Health had published policies that were meant to curb financial conflict of interest. Over the years, several amendments have been made by the government concerning conflict of interest.

Moreover, federal and state rules regulate institutional conflict of interest. For example, the state of California requires that all institutions fill an economic interest form (FPPC Form 700-U) to monitor the practice of medicine by doctors (Easley, 2017). The predictable future of conflict of interest law will see the establishment of more strict laws that regulate the establishment of new pharmaceutical companies or new health facilities. However, the extensive use of smartphones will result in online consultation services by medical professionals, which are hard to monitors.

Anti-trust laws

To protect citizens from predatory business practices, the US government passed the anti-trust laws that ensure fair competition within the economy. Therefore, consumers are guarded against monopoly businesses. The rules are meant to control prices for drugs, thereby reducing the expenses met by the patients. Historically, the Sherman Act of 1890 was the first law to be enacted by the federal government to regulate competition within the economy(HAVIGHURST, 2005). The bill was supposed to minimize the power of cartels and prohibit the rise of monopolies. The antitrust division of the government was formed, and it was mandated with enacting the law.

There were concerns on the antitrust law, and different cases were presented before the court on the same. The state governments were given the power to file suits to enforce the federal antitrust laws. Of the many cases, UNITED STATES v. SOUTH-EASTERN UNDERWRITERS ASSOCIATION, 322 A.S. 533 (1944), was directly applicable to healthcare practice within the nation (Lopatka, 2018). The case ruled in favor of UNITED STATES that not all insurance companies were exempted from anti-trust regulation. Therefore, medical insurance was regulated. The law still holds, and it protects consumers from exploitation by insurance companies. Besides, there is a regulated production of drugs by pharmaceutical companies.

The state and federal governments work together to ensure that competition of companies does not affect the delivery of healthcare within the country. In the future, it can be predicted that citizens will use the national insurance scheme widely and pharmaceutical companies together with private hospitals will be compliant with the antitrust laws. The effect of this scenario will be improved healthcare delivery and minimal patient exploitation.

Conclusion

Overall, the realization of a well-controlled healthcare environment, there is a need for the state and the federal governments to work in collaboration. The Medical Practice Act regulates healthcare facilities and medical professionals. Compliance with the law is key to improve the quality of care within the nation.

References

Alkhateeb, F. M., Shields, K. M., Broedel-Zaugg, K., Bryan, A., & Snell, J. (2011). Credentialing of pharmacy technicians in the USA. International Journal of Pharmacy Practice, 19(4), 219-227. doi:10.1111/j.2042-7174.2011.00095.x

Baker, T. M. (2015). Medical Malpractice Insurance Reform: “Enterprise Insurance” and Some Alternatives. Medical Malpractice and the U.S. Health Care System, 267-290. doi:10.1017/cbo9780511617836.015

Bal, A. K., & Bal, B. S. (2013). Medicolegal Sidebar: State Medical Boards and Physician Disciplinary Actions. Clinical Orthopaedics and Related Research®, 472(1), 28-31. doi:10.1007/s11999-013-3364-1

BHIMJI S., & SHARMA S. (2018, October 27). Credentialing – StatPearls – NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519504/

Easley, T. J. (2017). Medical Journals, Publishers, and Conflict of Interest. JAMA, 317(17), 1759. doi:10.1001/jama.2017.3421

Fred, H. L. (2016). Cutting the Cost of Health Care: The Physician’s Role. Texas Heart Institute Journal, 43(1), 4-6. doi:10.14503/thij-15-5646

HAVIGHURST, C. C. (2005). Antitrust Enforcement in the Medical Services Industry: What Does It All Mean? Milbank Quarterly, 83(4), no-no. doi:10.1111/j.1468-0009.2005.00430.x

KASS J.& ROSE R. (2016). Medical Malpractice Reform—Historical Approaches, Alternative Models, and Communication and Resolution Programs. The AMA Journal of Ethics, 18(3), 299-310. doi:10.1001/journalofethics.2016.18.3.pfor6-1603

Lopatka, T. J. (2018). Cross-Market Mergers in Healthcare: Adapting Antitrust Regulation to Address a Growing Concern. doi:10.31228/osf.io/pqr9f

 
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