PSROs, the medical profession, and the public interest

The federal legislation mandating Professional Standards Review Organizations to monitor the decision making of physicians regarding their patients is a method unique to the United States to control medical care costs according to prevailing professional criteria. Other countries, so far, depend largely on health service structures, reimbursement methods, and arbitrary government budget limitations. Our dislike of highly structured delivery systems has pragmatically moved us in the direction of monitoring diagnostic and therapeutic decision making. PSRO is mandated at a time when there is no systematic methodology with validated criteria for monitoring medical practice. This will likely lead to subtle sabotage of PSRO by the medical profession justified by quality standards which are the professions' prerogative. It is conceivable that quality standards will rise and, therefore, costs. The drive for monitoring physician decision making is understandable even when there is no methodology. It then behooves medical schools to conduct research on methodologies of monitoring services, a possible favorable side-effect of the legislation. An unfavorable side-effect may likely be that the criteria will be based exclusively on technical medical considerations and ignore the personal and social attributes of patients which should affect the decision making of physicians. Medicine will then become even more technocratic than it is now. All countries are converging at various degrees of intensity in establishing planned limits to expansion, examining possibilities of monitoring physician decision making and capping this off with arbitrary budget ceilings. The state of the art of health services management appears to permit no other recourse.