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The Political Context of Health Service Regulation

Can regulation work in health services, given the present political context? General issues in the regulatory process are discussed, followed by a consideration of the relevance of these issues to the health care field. Regulatory processes are reviewed for the United States in four areas: credentialling of people, surveillance of delivery systems, quality of materials and technology, and rate-setting or cost control. It is concluded that the process cannot work. Four alternatives are presented and briefly evaluated: tinkering, centralized regulation, national health service, and general nationalization of most major economic sectors.