Oversight of Medical Care Quality:

Abstract

Not long after physicians began to gather in organized groups and form professional societies in the 19th century, it became clear that education, training and practices were highly variable and that oversight to prevent outright quackery was needed. Although the situation is quite different today, experience has shown that continued oversight of medical care is still necessary. Some modern physicians may allow their knowledge, skills, and practices to become out of date, resulting in ineffective, unnecessary and expensive care. They may engage in any number of unprofessional behaviors, ranging from substance abuse to billing and insurance fraud, leading to disciplinary actions by external agencies. That said, providing oversight in today's highly complex health care delivery system is not a simple task to accomplish. Many rules, regulations, structures and processes have been put into place, all trying to ensure that medical care is safe, affordable and of high quality. This essay briefly describes the history and evolution of medical oversight — from its relatively simple beginnings in licensing and accreditation initiated over a century ago to the multiplex of oversight programs currently in place — including a look at some of the new, innovative and data-driven approaches being used today.