ABSTRACT
Throughout the Western world, health care systems are grappling with the problem of assuring quality while containing costs. On the one hand, governments and insurers argue that there must be some limit to the apparently endless growth of health care expenditures. On the other hand, patient groups and consumer advocates, already dissatisfied as a result of the problems in holding doctors accountable for their actions, assert that such limits must not prevent patients from gaining access to essential treatments. The two movements find common cause in the development of systems of regulation intended to police the quality of care. Some of these are initiated by individuals, like the tort system of litigation over particular acts of negligence or the work of licensing boards reacting to complaints about a physician’s fitness to practise. Others are corporate, as in the spread of medical audit or the introduction of schemes of managerial control. Such regulatory systems, it is believed, can combine the prevention of ineffective, dangerous or inefficient medical practices with the promotion of high technical standards of care and sensitivity to consumer demands or expectations.
