Licensing is a statutory mechanism by which a governmental authority grants permission to an individual practitioner to engage in an occupation or to a health care organization to operate and deliver services. Licensing allows governments to ensure basic public health and safety by controlling the entry of health care providers and facilities into the country’s health care market and by establishing standards of conduct for maintaining that status.

Licensing differs from other approaches to quality regulation in that it is mandatory and is performed uniquely by a government agency. Licensing regulations also specify the time period for which the license is valid and the required procedure for maintaining or renewing the license. Assuming that problems with the provider or facility have not been identified or reported, licenses may often be often renewed with the payment of a specific fee or submission of documentation.

Licensing standards are typically set at a minimum level, defined by the government as that needed to ensure health and safety in that country. For individual providers, licensing standards are usually defined in terms of training (e.g., completion of degree from an acceptable training institution) and demonstrated technical competence (e.g., passing of a licensing examination).  Although licensure exams are the most common example of regulation through licensing, other regulatory programs related to licensing include the reciprocal granting of licenses to professionals of other countries, establishing standards for professional practice, and developing systems to investigate and punish professionals that violate professional license standards.

Similar to licensing is registration, by which a provider may be admitted into a registry of providers recognized by the government as providers of health care services in the country. If registration requirements are based not only upon completion of educational requirements but also demonstrated technical competence, such as passing of a qualifying examination, the registration process may be a more effective mechanism for quality regulation. Registration has the added advantage of facilitating the creation a database of information about health care professionals that are practicing or intending to practice their profession in a given country.

Organizational licensing or registration is used in some countries to enable organizations to legally deliver health care services; granting of the license is often based on on-site inspection to determine if minimum health and safety standards have been met. The licensing of health care facilities differs from accreditation and certification in that it is mandatory, thus providing the government control over the entry and operation of health care facilities in the health sector. However, in some countries, a new registration or licensing process has been proposed for existing health care facilities that more closely resembles accreditation in the sense that detailed standards covering various functional areas have been proposed, with initial and subsequent evaluation of compliance, and the possibility of assistance being provided to facilities to help them achieve the standards.

A critical requirement for achieving the intended impact of licensing is to build in mechanisms to ensure that the desired performance or competence is sustained over time. Licensing only at the point of entry into the health care market is insufficient to provide assurance to the public and to health sector institutions that providers maintain competency throughout the span of their careers. Time-limited licenses and clear requirements for renewal are essential to create an incentive for providers to remain current through continuing education and for organizations to maintain physical infrastructure and capacity. A related issue is the need for enforcement of sanctions or consequences for loss or reversal of licensing status. This includes procedures for disciplinary action against licensees who fail to maintain the conditions of licensing as well as procedures for reporting and handling impaired or incompetent providers and facilities.

• Licensure, accreditation, and certification: Approaches to health services quality
• Approaches to healthcare quality regulation in Latin America and the Caribbean: Regional experiences and challenges