Health Affairs August 28, 2024
David A. Hyman, Sunjay Letchuman, Ge Bai

For more than 150 years, physicians shaped the regulatory environment in which they practiced medicine. Early regulatory steps, such as the establishment of educational standards by medical societies, were patient centered and physician led. By the 1970s, however, regulation was no longer patient centered or physician led; instead, the center of gravity had shifted to focus on regulating “the business of medicine”—and, not coincidentally, protecting incumbent medical providers at the expense of newcomers seeking to compete against them. In this Health Affairs Forefront article, we highlight three distinct examples of this phenomenon, each enacted during a different decade; explain their implications for patients and other stakeholders; and suggest several policy options for improving matters.

First, in the 1970s, many states...

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