Professional autonomy and accountability. A critique of current health reforms and an alternative proposal

Many countries have become increasingly concerned about the cost of health services, and the issue is considered to be a crisis in the United States. There are many factors that influence the performance of health service professionals, and they all need to be taken into account in reforming the industry. Accountability is important, but it must be compatible with the underlying character of health service delivery. A long-term programme needs to be developed to provide the environment in which professionals can work most effectively. This requires a greater emphasis on professionally-based processes that promote performance and provide accountability.