美國醫療證照管制政策之政治經濟分析

An Empirical Examination of the Political Economy of Occupational Licensing in the US Healthcare System

張其祿(Chyi-Lu Jang)

醫療證照 ； 管制政策 ； 公益理論 ； 管制俘虜 ； occupational licensing ； regulatory policy ； public interest ； regulatory capture

歐美研究

33卷1期（2003 / 03 / 01）

1 - 56

繁體中文

本文主要目的在於探索美國醫事專業人員之證照管制政策的形成原因，透過對美國各州五種主要醫事專業人員之證照管制措施的調查分析，本研究建構了一個整合各種主要政治及經濟影響因素的分析架構與多變量對數統計模型。本文經驗研究結果發現，無論是管制政策的公益理論，抑或是俘虜理論，均無法完整地解釋管制政策的形成原因，本研究結果顯示管制政策是受政策需求面與供給面中多元政經因素影響下的產物。

With a research emphasis on occupational licensure, this study develops a model of the decision by state legislators to regulate the entry and scope-of-practice of health occupations that incorporates both public interest and interest group forces, as well as factors with regard to the current structure and characteristics of the political and economic environment within which they operate. The model yields several testable hypotheses, and provides a framework within which one can explore the importance of competing forces in these decisions. Using this framework, the licensing legislation outcomes of five health occupations (medical doctors, doctors of osteopathy, physician's assistants, nurse practitioners, and certified nurse midwives) in the US are explored. Estimation of the multivariate logit model in this study reveals evidence of the effectiveness of organized interest groups and of the importance of the public interest in the adoption of occupational regulation. In addition, managed-competition is found to affect regulatory outcomes and become a driving force for the abolition of scope-of-practice licensure restrictions. The results of this study lend substantial support to a pluralistic model of the determinants of occupational regulation.

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