Competition Among Health Practitioners: The Influence of the Medical Profession on the Health Manpower Market. Volume II; The Childbearing Center Case Study

摘要

This case study which focuses on the Childbearing Center of New York accompanies Volume I of this report. The case study seeks to illustrate the barriers facing non-physicians who provide services traditionally offered by physicians and who represent potential physician substitutes in certain well-defined circumstances. The certified nurse-midwife profession presents an especially effective case for this analysis as the obstetrics market is a highly competitive one. Not only is it a market in which demand is limited, but it is one in which consumer preference as well as out-of-pocket expenses play a particularly noticeable role. The case uses an out-of-hospital birthing center staffed primarily by nurse-midwives as a vehicle to examine such issues as licensure problems for outpatient facilities staffed by alternative providers; and difficulties in obtaining physician staff and hospital back-up. Also discussed are ways in which the medical establishment responded to the opening of the center, and the effect of medical community pressure on its viability.