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Changing systems of external monitoring of quality of health care in the United States.

In the preceding article (p 97) I described the origins and current structure and functions of the principal systems of external quality monitoring in the United States. As institutions operating in a complex and sometimes contentious area, these organisations have been subject to several pressures for change. This paper examines five of these pressures (box), among which perhaps the most important potential influence is the question of national health care reform.