Peer Review Organizations: Scientific Challenges in HCFA's Health Care Quality Improvement Initiative

Since the early 1960s, public policymakers have focused on health care issues and the need to improve the health care system of the United States. At first, the predominant concern was access to health care. This led Congress to establish programs such as Medicare to improve access for special populations. In the 1970s, the emphasis of health care policy shifted to costs. The dramatic rise in federal expendi-tures for health care, especially within the Medicare program, prompted Congress to mandate a system of peer review, accompanied by regula-tory payment systems, to evaluate and control the costs of the health Address correspondence and requests for reprints to: Risa P. Hayes, Ph.D., Fellow, Thomas