Why some change and others do not: Understanding the effects of competition in overlapping professional jurisdictions on states, healthcare markets and training programs

Institutional theory is utilized to understand the role of the state in determining who among overlapping professions are allowed to compete in healthcare markets. Hypotheses are tested using a professional licensing policy innovation that influences the evolution of markets for healthcare services. This first paper demonstrates how the power of incumbent and challenging professional associations, the characteristics of a state's labor market, and previous adoptions by neighboring states affect a state's propensity to embrace or resist state legislation of professionally-contested healthcare licensing legislation over a 10-year observation period. The results of this research have implications for understanding state healthcare market innovations, the power of professional associations, and institutional theory. Two subsequent papers address the effects of this competition on training programs in the challenging profession.