Regulating Quality and
William L. Roper
Striking a balance between the often-competing objectives of efficiency, accessibility, and quality in health care requires governmental intervention. The challenge lies in identifying the appropriate role for government—a challenge that is particularly daunting in the area of health care quality.
Health Care Regulation
Historically, our nation has relied primarily on industry selfregulation rather than government intervention for assuring clinical quality (Brennan and Berwick, 1996). It has long been argued that only health care professionals and organizations themselves have the necessary expertise to develop and enforce rules for such highly specialized and rapidly evolving fields of practice. By contrast, governmental roles in financing health services have become widely accepted and practiced, both in purchasing health care through public programs such as Medicare and Medicaid and in regulating the health insurance industry. Federal and state governments have proven to be relatively effective in making eligibility and coverage decisions for public programs, as well as in establishing standards for the private insurance industry in areas such as financial solvency, benefit determination, and consumer grievance processes.