Professional Competition and its Influence on Access in Primary Health Care
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2023-05-29
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Abstract
Due to the low availability of family physicians, Canadians are currently experiencing a crisis in access to primary health care (PHC). Interprofessional collaboration, supported by expanded scopes of practice for non-medical professionals, has been repeatedly presented as a potential solution to the challenges that have led to the access crisis. This capstone argues that interprofessional collaboration is likely to remain an ineffective policy goal as long as decision makers continue to neglect the self-serving and competitive character of interprofessional interactions. It argues that collaboration's unacknowledged second face is competition, and that fair and full competition is a likely solution to the access crisis and making good on collaboration's promises. Medical professional dominance in PHC has created an anti-competitive environment that allows physicians to subordinate other professions, leading to under-utilization of non-medical professionals and so the inhibition rather than expansion of access. An example of this is presented in a case study of non-medical prescribing. Reports from the United States and Europe suggest that supporting fair and full competition amongst health professions can improve access. Those reports provide details on the regulatory requirements for creating a health professionals' market that would allow for barrier-free competition, full patient choice, and the fruition of interprofessional collaboration's promise. This capstone concludes that PHC policy needs to move away from collaboration rhetoric and should focus on designing a system that optimizes the competition between health care professions for the benefit of Canadians.
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McDonald, A. (2023). Professional Competition and its Influence on Access in Primary Health Care (Unpublished master's project). University of Calgary, Calgary, AB.