ABSTRACT
Relating medical care funding to health status in community may be powerful as both a symbolic restatement of societal expectations of medical care and an economic spur for medical self-regulation to be conducted more in harmony with public regulation. The self-regulating profession has responsibility for divining society's goals and expectations, and for developing accountability mechanisms that translate them into the actual behaviour of its organizations and members. With the changing understanding of the determinants of health and a growing realization of the questionable scientific basis for a good deal of medical practice has come a willingness both to question open-ended budgets and to scrutinize self-regulation. The self-regulation process in medicine has focused on the individual practitioner-patient encounter, a framework that both discourages resource consideration in making judgments of "good care" and makes it difficult to ascertain overall impacts on population health.
