The Next L.A. / Reinventing Our Future : Health Care : IDEA FILE: Universal Privileges

All medical professionals--including doctors, nurses and technicians--would be licensed and credentialed to work at any hospital or other health facility. Doctors would be able to admit patients to the type of facility that best suits the patient’s needs, not simply to the hospital where the doctor has admitting privileges, as happens now.

Benefits: After an earthquake or during riots or other disasters, health care workers could be dispatched to serve where they are most needed.

Short-term or Long-term Impact? Long term.

Supporters: Advocates say that universal licensing and credentialing would do away with some of the fragmentation that currently blocks people from contributing skills where the health care system most needs them. There already is movement toward basic universal credential standards.

Opponents: Credentialing by individual hospitals, clinics and other health facilities has been an important mechanism for maintaining quality. Doctors and other medical professionals are not equal in their experience, skills or competence. A universal credentialing system would require rigorous professional standards and enforcement. In addition, health care facilities are unlikely to go along with the idea unless they get immunity from malpractice suits for mistakes these universally credentialed professionals might make under their roof.

The Costs: The main financial issue would be how to pay the doctors and hospitals. Many insurance plans today require doctors to admit patients to certain hospitals and refuse to pay the bills if another hospital is used. Similarly, these plans require patients to seek care only from affiliated doctors. And health insurers now also pay different rates to individual doctors and hospitals for the same work.

REALITY CHECK: Possible.