Health policies and data

The Balance between Professional Self-Regulation and Accountability for Monitoring and Improving Quality of Care


The OECD released a study on Improving the performance of health care systems: From Measures to Action (A Review of experiences in four OECD countries) on January 2002.

Monitoring and improving quality of medical care or, more precisely, the technical quality with which medical care is provided, has recently become a priority issue for policymakers in many OECD countries. It has begun to assume parity of importance with cost and access among the main concerns of health policy.

The very fact that policymakers perceive a necessity to address this issue represent a paradigm shift, as it was formerly taken for granted that the institutions of professional self-regulation would ensure adequate quality of care. However, as scandals and evidence of medical errors and quality shortfalls have emerged in various OECD countries, doubt has been cast on the ability of those institutions to live up to their responsibilities. Many countries have begun exploring alternative approaches, such as increasing the transparency and accountability of clinical performance. Such approaches will represent a fundamental change in a long-standing implicit arrangement between the medical profession and society, under which the profession guaranteed effective self-regulation of its members in exchange for exclusive rights to practice, societal prestige and above-average earnings.

To be able to design new approaches to quality monitoring and improvement, health policy makers will need to understand the likely origins of those findings, their magnitude relative to other sectors of the economy and potential models of improvement. There is much potential in sharing the experiences in different countries to understand which factors are conducive to the design of successful models.

In general, three policy options exist to reform existing arrangements for performance measurement and improvement:

  • Strengthening and/or modifying the institutions for professional self-regulation
  • Using improved information to strengthen 'external' regulation
  • Providing consumers with sufficient information about performance and with choice of providers so that market forces can lead to better quality

These choices raise technical, economic and political issues. In particular, they have different implications for whether the benchmarking of performance is open or closed to public view. Thus, this part of the OECD Health Project will investigate case studies of the changing balance between 'external' performance measurement activities and clinical 'self' regulation, with a view to assisting countries to share their experiences.

The study described and evaluated current approaches to quality monitoring and improvement in selected OECD countries and assessed whether the approaches result in a regulatory framework and incentives to foster quality improvement. Four OECD countries (France, the Netherlands, New Zealand and Sweden) has been selected to reflect the variety of types of health care systems found in the OECD. The study was based on a literature review, including studies on best practices in quality assurance, and interviews with key stakeholders (government officials, professional associations, private and public insurers, patient groups) in the countries concerned.

OECD Health Policy Unit: