The full content of Annals is available to subscribers

Subscribe/Learn More  >
Position Papers |

The Oversight of Medical Care: A Proposal for Reform

American College of Physicians*
[+] Article, Author, and Disclosure Information

Requests for Reprints: Linda Johnson White, Director, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(5):423-431. doi:10.7326/0003-4819-120-5-199403010-00011
Text Size: A A A

The oversight of medical care, in the form of peer review, has traditionally been used to ensure that the highest standards of care are maintained. What is relatively new is the external oversight of medical practice carried out by a growing number of independent entities (government, third-party payers, for-profit firms, for example), overseeing care in uncoordinated ways. Tensions arise when reviews of utilization and reviews of quality are conducted by different organizations with conflicting goals. The review instruments are still crude and have neither been adequately tested nor validated. Future attention to developing reliable and valid measures of efficiency and quality is essential. Evidence suggests that the principal process of review, the case-by-case review, may not be cost-effective and may not be conducive to improving quality. It should be replaced by profiles of practice patterns at institutional, regional, or national levels. We propose a model of oversight that emphasizes the appropriate balance between internal mechanisms of quality improvement and external accountability. In this model, internal and external reviews have specific, complementary roles that promote efficiency and quality. Detailed monitoring of quality and problem solving are left to providers who are intimately involved with care. In return, they become accountable to payers and the public through the surveillance of patterns of practice.

*This paper, authored by Anne-Marie Audet, MD, MSc, SM, and H. Denman Scott, MD, MPH, was developed for the Health and Public Policy Committee: Clifton R. Cleveland, MD, Chair; Cecil O. Samuelson, MD, Vice-Chair; Christine K. Cassel, MD; David J. Gullen, MD; Ernest L. Mazzaferri, MD; Quentin D. Young, MD; Whitney Addington, MD; Robert A. Berenson, MD; John M. Eisenberg, MD; Nancy E. Gary, MD; P. Preston Reynolds, MD; Gerald E. Thomson, MD; Mack V. Traynor, Jr., MD; Sankey V. Williams, MD. Approved by the Board of Regents on 29 March 1993.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.