Health system reform. Forward or backward with quality oversight?

IN HIS September 22,1993, health system reform speech to the nation, President Clinton stated: "If we reformed everything else in health care, but failed to preserve and enhance the high quality of our medical care, we will have taken a step backward, not forward." The Health Security Act that the president actually submitted to Congress, however, largely dismantles the system that has evolved for external oversight of the quality of health care in the United States without putting in its place an adequate alternative means to assure health care quality. The most popular congressional alternatives to the Clinton plan give even less attention to quality issues. Indeed, health system reform threatens to take us backward rather than forward with respect to external quality oversight. The field of health care quality oversight has long been characterized by a certain faddishness. Ideologies, methodologies, and programs have come and gone with astonishing rapidity,