Government Licensure and Voluntary Standards for Health Personnel and Facilities

Associate Professor of Preventive Medicine, University of California, Los Angeles, California. t Associate Researcher in Health Law, University of California, Los Angeles, California. This paper has been developed by expansion and revision of a position paper entitled "Licensure, Accreditation, and Certification as Assurances of High-quality Health Care," delivered at the 1968 National Health Forum. The original position paper will be published in the proceedings of the 1968 National Health Forum. governmental approval of personnel, educational programs, facilities, and services are generally more than minimal, and strive to promote excellence.2 Specification of standards for certification of specialists and requirements for hospital committees and staff privileges, and required use of consultants in hospitalized cases not progressing satisfactorily, are examples of voluntary control that have far-reaching effects on quality of care. This nongovernmental regulatory process affects the daily operations of practitioners and institutions. Peer group evaluation of physician activities, through utilization review, tissue committee review, and medical audit, can deal with many factors affecting performance, such as ordinary incompetence in the exercise of skills, lack of specialized skills, and diminution of skills as a result of age, debilitation, drug addiction, or alcoholism. Such nongovernmental supervision of practice supplements effectively governmental processes in cases involving alleged violations of licensure laws which entail quasi-criminal penalties. Proof of improper practices in nongovernmental supervision need not be so formal nor so full as in cases involving the governmental process; nor must the alleged violations conform to the rigid stat