Health professions regulation and public policy: State medical boards as policy actors

Regulation of health professions changed in the 1990s. The political-institutional arrangements between social interests, the state and economic actors, are different from what they were twenty years ago. Among the reasons for these changes is the turbulence that characterizes the health care world. States have also become more active in the health arena with devolution. State leaders—governors, legislators and attorneys general—are more actively engaging social issues than was the case in the past.;Change has occurred relatively fast. Previous stakeholders have been joined by new entrants who desire a voice in the process. As a consequence there have been tangible changes in federal and state health laws and policies. The scope of policy conflict has expanded. Some of the changes in law and policy result directly from changes in health care management and the structure of the health care market. Others emerge from new regulatory policies adopted by states.;This study looks at change and how it affects one state health policy actor—state medical boards. Changes in the health delivery system have put health oversight and regulatory agencies, such as medical boards, under increasing scrutiny and pressure. In response to more public attention, medical boards have changed the way they conduct their business.;This study examines why some state medical boards are leaders in change while others are not. It considers the institutional structure of medical boards, their relationships with the legislature and interest groups, and their policy and routine behaviors. The research questions are: What is the role of the enabling coalition in the institutional design of state medical boards? What is the role of institutional design in predicting legislative involvement in agency policy activities? What factors influence a state medical board's non-programmed policy decisions and behavior? What factors influence a medical board's programmed decisions and behavior?;The study addresses the research questions using original data drawn from a 50-state survey of medical boards, data collected by the Federation of State Medical Boards (FSMB), and a series of four analytical case studies that include interviews with board members, staff and informed observers.;Overall the research findings indicate that there is one primary influence on state medical boards—legislators. Both at the individual level and through their involvement in specific medical board issues, state lawmakers have a critical effect on medical boards and their activities and behaviors. Medical associations, governors and board autonomy, among other things, are less important factors in medical board structure, behavior and activities. The two most active policy players in medical board matters are legislators and state medical societies.