In fiscal year 1973, aggregate national health expenditures totaled $94 billion, with 40 percent representing public funds. The magnitude of these expenditures combined with increased public dissatisfaction with the inflationary spiral in medical costs, the uncertain quality of medical services, and the confusing multiplicity of medical care delivery and payment mechanisms--underscore the need for a comprehensive system of public accountability.
Accountability concerned with both the cost and quality of medical care is particularly needed in reference to the services provided in the Medicare and Medicaid programs, and Congress has indicated that it will be needed even more urgently when an expanded national health insurance program is enacted. Accountability is owed to the public in general, to taxpayers, to Congress, to the planners and providers of medical services, and to the millions of patients who seek medical care in a marketplace where access to services is often limited or prohibited by lack of income, lack of insurance coverage, or lack of adequate medical resources; where the customary ability of consumers to make viable choices about goods and services is severely impeded; and where government intervention on their behalf has been predicated on a concept of medical care as a basic human right.
In recognition of the need for accountability, Congress has enacted legislation establishing Professional Standards Review Organizations in approximately 200 medical service regions throughout the country, with full nationwide implementation scheduled for 1976. Professional Standards Review Organizations--to be sponsored and operated by practicing physicians--will (1) conduct systematized professional review of services provided in Medicare and Medicaid; (2) develop criteria, norms, and standards of treatment by means of which to measure the quality and appropriateness of medical services; (3) correct deficiencies discovered in the treatment patterns of individual practitioners and institutional providers; (4) contribute to the ongoing education of physicians; and (5) evaluate, and recommend improvements in, the overall medical care delivery systems. By achieving these objectives, Professional Standards Review Organizations should help the nation realize its potential for a consistently high level of quality in both public and private medical care at a reasonable cost.
Many issues surround the growth of government participation in medical care in general, and the development of Professional Standards Review Organizations in particular. Some of these issues have been resolved by the experience of foundations for medical care and other experimental review organizations. Other issues remain crucial. Their successful resolution will depend to a large extent on the ability and willingness of health care administrators in the public sector and medical professionals in the private sector to cooperate in working toward the common goal of an equitable, efficient, economical health care system.
Level of Degree
School of Public Administration
First Committee Member (Chair)
Albert H. Rosenthal
Second Committee Member
Thomas Struever McConnell
Third Committee Member
Donald Winston Smithburg
Cole, Richard W.. "Public Accountability In Medical Care: The Role Of Professional Standards Review Organizations.." (1974). https://digitalrepository.unm.edu/padm_etds/40