PSRO--quality control? Or gimmickry?

The implementation of quality control programs of health care service requires a technology no less complex than that of the quality control program itself. Previous efforts to implement programs where health care practitioners are truly accountable have foundered on: 1. The lack of enthusiasm of major third party payers, 2. The functional inadequacies of Medicare utilization review committees, and 3. The conflict of interests of medical societies. For the Professional Standards Review Organizations (PSRO) to be effective rather than ceremonial, evaluation that is arm's length between evaluator and practitioner is indispensable. The PSRO is the last chance for organized medicine to demonstrate that it can and will control those practitioners who habitually do violence to its ethical and professional norms. The paper lists other options should the presently structured PSRO program fail.