This paper examines the Pew Health Professions Commission's Taskforce on Health Care Workforce Regulation report and its ten recommendations for reforming how states license, oversee, and educate health care practitioners. The paper outlines the SAFE framework — Standardized, Accountable, Flexible, and Effective — that guided the taskforce's vision, summarizes each recommendation, and then evaluates how four states have responded. California's voluntary self-regulation of alternative practitioners, Utah's outdated physical therapy continuing education requirements, New York's cultural competency mandates, and New Jersey's nursing standardization efforts are each assessed against the taskforce's goals.
It has been a decade since the Pew Commission issued its report on the Taskforce on Health Care Workforce Regulation, and in that decade the American public has begun to demand changes in the way the health care system in this country is operated. Currently there are millions of workers who are not provided with or offered health care benefits, while the price of health care continues to rise.
One of the most controversial issues in the field of health care is the question of financing structures and market forces. Managed care has become much more common than in the past, and with this system comes managed financing and structures.
These transformations are also bringing increased emphasis on primary care, prevention, population-based practice, interdisciplinary teamwork, and clinical effectiveness research. These changes have highlighted the roles that America's 10.5 million health care practitioners play in the cost, quality, and accessibility of health care. Consequently, their education, training, and distribution have received increased attention. Likewise, the current health care workforce regulatory system is under scrutiny (Taskforce, 1995).
The report indicated that what had worked in the past was out of step and behind the times with respect to current health care needs and expectations. The public had been up in arms for many years about the rising cost of health care, the quality of health care delivery, and the treatment of those without health care coverage.
The trade commission had previously reported that while occupational licensing requirements protect the safety of the public consumer, the costs of those licenses and associated insurance drive up the cost of health care, and that cost is ultimately passed on to the consumer (Taskforce, 1995). The report provided ten recommendations designed to help address the health care dilemma facing American consumers. Those recommendations have been followed in part, but not in full, as states work their way through the ongoing health care crisis.
One of the things the report acknowledges is that health care reform efforts have been divided into fifty individual state processes. This has created a problem of patchwork organization and a lack of uniform regulation with regard to health care cost and delivery.
The report analyzed and examined areas of health care it felt were most pressing for the nation at the time. Upon its conclusion, the Taskforce put forward ten recommendations it believed would help alleviate the current crisis. The report also introduced an acronym for what it was trying to accomplish. S.A.F.E. stands for:
To understand how effectively various states are meeting the recommendations of the report, it is necessary to know what those recommendations consist of.
The first recommendation called for states to use standardized and understandable language for health care functions. This was recommended so that the average consumer could take an active and informed role in his or her health care decisions.
The second recommendation called for a standardized method for practice requirements (Taskforce, 1995).
The third recommendation was for states to base their practice acts on demonstrated competence. This included the willingness of different types of practitioners to overlap their skills and services, which would benefit the consumer by providing a wider array of practices to choose from and facilitate mobility within the health professions (Taskforce, 1995). As the report stated: "States should explore pathways to allow all professionals to provide services to the full extent of their current knowledge, training, experience, and skills."
The fourth recommendation was that states work to redesign their health care professional boards so that they better reflect accountability to the public.
The fifth recommendation called for boards to educate consumers, allowing and assisting them to obtain and understand information so they could make informed decisions about the choice of practitioners. This recommendation was also aimed at improving public accountability in this area of health care (Taskforce, 1995).
The sixth recommendation mandated that boards cooperate with both private and public organizations on the collection of data about regulated health professions. The recommendation emphasized the importance of collecting data to support an effective workforce plan.
The seventh recommendation provided that each state require its boards to design, develop, and begin implementing competency requirements that assure the public that health care professionals are meeting continued competence standards (Taskforce, 1995).
The eighth recommendation — not separately detailed in the report excerpt — precedes the ninth, which calls for the maintenance of fair and cost-effective disciplinary policies that would exclude practitioners found to be incompetent in their field or specialty. This recommendation serves to protect the American public from incompetent health care. It is aimed at preventing practitioners who lack the necessary skills from delivering substandard care that can cause a consumer's health to decline or fail entirely. Beyond the serious risks of poor health or death, an incompetent practitioner can also significantly diminish a patient's standard and quality of life (Taskforce, 1995).
The ninth recommendation of the report calls for individual states to develop evaluation tools for assessing the objectives, successes, and failures of regulatory systems and bodies, so that the public's health interests can be both promoted and protected (Taskforce, 1995).
The tenth and final recommendation deals with understanding the links, overlaps, and conflicts between health care workforce regulatory systems and other systems involved in the education, regulation, and practice of health care practitioners.
Although many states recognize the implications of using non-standard terms for regulatory functions, few have enacted standards for regulatory language. As a promising example, Montana recently adopted a Uniform Licensing Act, which establishes uniform guidelines for the licensing and regulation of professions and occupations under the jurisdiction of professional and occupational licensing boards (Montana Department of Commerce, 1995).
In plain terms, the language used in many health care regulatory practices is so complicated that the average consumer cannot begin to understand its meaning. This creates a historic barrier between the health care profession and those it is paid to serve, establishing a distance between practitioners and the public. The report acknowledges this problem and offers ten recommendations that, if followed, it believes will make it easier for consumers to engage with the scope and sequence of health care regulation in their state.
It is impossible for consumers to know whether something is being done correctly if they cannot determine what is or is not supposed to happen under the regulations and mandates that their practitioner must follow. The report illustrates this with an example:
"For 20 years, a Swedish-trained physical therapist obtained a license from and practiced with an unblemished record in two states and one Canadian province. When she moved to a third state, where entry-to-practice requirements called for a certain number of academic hours in specific fields, she was missing six 'general education' hours (not related to physical therapy) and was denied a license. No credit was given for 20 years of excellent practice and an apparently equivalent education (Taskforce, 1995)."
This example illustrates the problems caused by the lack of a standardized method for clarifying professional experience and entry licensing criteria.
"Four states assessed against taskforce recommendations"
The taskforce report was instrumental in identifying and illuminating many aspects of regulation in the health care field that were confusing to the consumer. With the recommendations being followed in various states, the public's safety and freedom of choice with regard to health care needs is further supported.
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