Regulation in Practice
In this final section, we focus on the practical side of instituting regulatory reform. First we consider how a regulatory apparatus might be structured, then we review the structure that was recommended in California. Finally, we examine the cost of proposed managed care regulations and consider why there has been such a large variation among the different researchers who have estimated the costs.
In the first chapter, Phil Nudelman provides an overview of different models that could be employed in setting and enforcing standards. Observing the rapid change that has occurred in health markets and the proliferation of regulatory measures to deal with those changes, Nudelman recognizes the need for both consistent and enforceable standards. Indeed, he speaks of a “flexible regulation model for national enforceable standards.” The challenge, as he sees it, is to ensure adequate protection of consumers without impeding the ability to innovate and improve quality, while at the same time being mindful of the cost. He considers a range of options balancing the responsibility of creating standards among public, quasi-public, and private bodies, with the responsibility of enforcement divided among the states, the federal government, and voluntary accreditation.
Sara Singer and Alain Enthoven report on the California Health Care Improvement Task Force. This task force was created by the governor of California in 1997 and issued a comprehensive