Stone D
J Health Polit Policy Law. 1977 Spring;2(1):32-47. doi: 10.1215/03616878-2-1-32.
This paper examines the new Professional Standards Review Organizations (PSROs) program in light of a similar program ("Economic Monitoring") that has been used in West Germany for over forty years. In the first section the PSRO program is described as government-mandated peer review by professional organizations, and is compared with that of the West Germany system. The second section argues that the PSROs are likely to strengthen the organization of established medicine, to increase the bargaining power of professional organizations, and to further insulate professional behavior from public scrutiny. The third section describes some of the effects of bureaucratic rigidities in peer review on the practice of medicine: the preservation of old technologies, the development of fixed patterns of practice, and the strengthening of the technical and interventionist biases in medical care. The final section evaluates the PSRO program as a complete delegation of congressional authority and a failure of Congress to set any rules for the development and application of norms and standards. The lack of any mechanism for accountability of the PSROs to public and choices is emphasized.
本文参照西德已实施四十多年的类似项目（“经济监测”），对新的专业标准审查组织（PSROs）项目进行了研究。在第一部分中，PSRO项目被描述为专业组织受政府委托进行的同行评议，并与西德系统的项目进行了比较。第二部分认为，PSROs可能会加强现有医学体系的组织架构，增强专业组织的议价能力，并使专业行为进一步免受公众监督。第三部分描述了同行评议中的官僚主义僵化对医疗实践的一些影响：旧技术的保留、固定医疗模式的形成，以及医疗保健中技术和干预主义偏见的强化。最后一部分将PSRO项目评估为国会权力的完全下放，以及国会未能为规范和标准的制定及应用设定任何规则。文中强调了PSROs缺乏对公众负责的机制以及缺乏选择机制。
