Politics or Public Interest? Licensing and the Case of Respiratory Therapists

Abstract

Does occupational licensure protect the public or do service providers seek it—as the “political theory” of regulation suggests—to restrict entry into their profession? Or perhaps licensing is most common in professions that are well organized and where there is some efficiency gain from licensure.1This paper summarizes two studies of these competing explanations. First, I examined 131 Illinois professions, 35 of which were licensed at the time of the analysis (1997), to determine which attributes of a profession made it more or less likely to be licensed by the state. I used liability premiums as a proxy for the danger posed to the public by members of the profession, and the size and budget of the profession’s state association as proxies for the degree to which the profession is politically organized. I also gathered data on the client type for each profession to test the supposition that institutional employers (hospitals, for example) will be more effective than individual consumers in organizing to oppose licensure for a profession.Second, I examined a single profession, that of respiratory therapists, who were licensed in 35 states and the District of Columbia at the time this study began (1997). I sought to determine the factors, including political influence, that best explain the pattern of licensure for respiratory therapists at the state level. Both studies lend support to the political theory of licensure.