Professor Jacobi's essay analyzes the various regulatory responses that are available to the government when crises in quality of care occur. These responses range from complete government involvement, i.e. "command and control" regulation, to a limited caretaker role in maximizing market forces. In responding to the recent IOM Report on human error in medical care, Professor Jacobi looks back to the 1986 IOM Report that revealed the crisis of care going on in nursing homes as well as the more recent controversy involving managed care. Following his analysis of the varied governmental approaches to these issues, Professor Jacobi concludes that both the unfettered use of command and control regulation and the more limited remedies of market maintenance are inadequate in the face of medical error. He argues instead that limited but forceful governmental regulation should be predicated on understanding the limitations of professionalism and market forces, in order to fully protect patients who are at risk.

First Page