The Future

In the future, licensing, regulation, and disciplinary action will no doubt respond to greater consumer insistence on quality and cost control, thus limiting professional autonomy still further. Meanwhile, new communication modalities will make possible much greater communication with all healthcare professionals as well as with the public. Three major trends can be discerned.

First, higher and more public standards for certification can be expected. Nonprofessional members have already been added to licensing boards in most states (CSG/CLEAR). It is likely that legal statutes will be enacted requiring that health professionals be recertified at some point or at regular intervals in their careers. The public is acutely aware that the scientific foundations of healthcare are rapidly changing, and that professional education has a half-life of less than ten years—five, in the case of certain medical specialties. Mandatory continuing-education requirements are already part of the licensing laws for medicine and nursing; it is not a large step from there to provisions for occasional retesting. Some observers foresee that "good moral character" requirements—already part of the licensing statutes in most states but undefined—will be made more precise and will be more vigorously enforced (CSG/CLEAR).

Second, the effort to control costs will be continued, whatever the fate of current insurance arrangements. There is still a widely held perception that health costs are too high and out of control. Major initiatives to limit them have been less than fully effective and have roused ire among health professionals and the general public alike. Yet to this moment there are no laws specifically excluding commercial arrangements from the healthcare marketplace, even those that entail the exclusion of sick people from private health insurance. The Health Insurance Portability and Accountability Act of 1996 (HIPPAA) at least ensures that a person who becomes ill when insured, and then must change insurance plans, can enroll in the new one. In the past, the illness would constitute a pre-existing condition, a sufficient disqualification for enrollment in a new plan. But we have still no way to care for those suffering from serious chronic conditions prior to any insurance coverage.

Third, the entire process of licensing, regulating, and disciplining health professionals will become much more transparent. Both professionals and consumers have demanded this. As an encouraging start, many states have created web sites containing information on how to apply for licensure, listing job openings, and publishing all state laws regarding licensure.

The United States entered the twentieth century with the assumption that only one consent was needed for medical treatment: that of the physician or other health professional. In the last decades of that century it became clear that three consents are needed: the professional's, the patient's, and the payer's—the government agency or the private insurance company. That third consent may become much more problematic. Patients are also taxpayers and ratepayers. There is an increasing mandate to limit the amount of the national wealth that goes into healthcare, and there is no telling how far this new stringency will go in reshaping the health professions.

LISA H. NEWTON (1 995) REVISED BY AUTHOR

SEE ALSO: Impaired Professionals; Just Wages and Salaries; Labor Unions in Healthcare; Malpractice, Medical; Mistakes, Medical; Nursing, Profession of; Research, Unethical; Nursing as a Profession; Nursing Ethics

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