About two-thirds of funding for substance abuse treatment comes from taxpayers.
ID: 2507569 • Letter: A
Question
About two-thirds of funding for substance abuse treatment comes from taxpayers. Are there
external benefits of substance abuse treatment that warrant this level of public funding?
Vaccination schedules are predictable, meaning insurance coverage for vaccinations does
not protect consumers against risks. Insurance coverage for vaccinations drives up costs
because more people get vaccinated if coverage is available and because insurers have
overhead costs. Does insurance coverage for vaccines do anything useful? Explain your
answer.
Why are many economists opposed to licensure of medical facilities and personnel?
Why would insurance coverage tend to increase rational ignorance?
Explanation / Answer
Medical licensure by the states has been common since the late nineteenth century, but certification is extensive as well. Physicians have been licensed by the states. The initial license is typically based on graduation from a medical school accredited by the Liaison Committee on Medical Education, completion of at least one year of graduate medical education in a residency program accredited by the Accreditation Council for Graduate Medical Education, and passing either the National Board of Medical Examiners Examinations or the Federal Licensing Examination. Renewal of the license often requires completion of a certain number of units of continuing medical education. A physician can have his license restricted, suspended, or revoked if the licensing board determines that the individual is unethical, impaired, or incompetent.
Physicians may also be certified by medical specialty boards. Those private organizations have established graduate medical educational (residency) requirements and give examinations to determine whether a licensed physician has met an additional standard. Over time, a larger proportion of physicians has become board-certified, as more physicians have sought to meet the requirements of their specialty and as additional specialties have established such a credential.
Other credentials exist as well. For example, a physician may have completed a course of study that "certifies" him to provide particular services, such as cardiopulmonary resuscitation or advanced cardiac life support, or to perform specific procedures. Many specialty societies offer honors such as fellowship in the society and awards such as the American Medical Association's Physician's Recognition Award.
The importance of credentials beyond licensure in the medical marketplace appears to be increasing. For example, HMOs and group practices use board certification in decisions about hiring physicians and in advertisements about quality. Hospitals use board certification and other credentials to determine whether a physician will be permitted to practice there and whether there will be any restrictions on procedures performed.
Insurers are beginning to use credentialling to limit payment for particular services to approved practitioners. In some cases approval is based on board certification in a particular specialty. Insurers are considering the use of credentials more closely tied to the specific service, such as specialized training or experience. Medicare limits coverage of transplants to "centers of excellence" that can demonstrate levels of experience and success rates. Several Medicare carriers (private insurers that process claims for Medicare under contract) require physicians to meet specific procedure-related educational and training requirements to be eligible to be paid by Medicare.
Such primitive logic explains how it is that interest groups and politicians with axes to grind