| Recent findings suggest that regulation imposes sizable costs on the healthcare system. At the same time, concerns about quality suggest additional regulation to prevent medical errors. Thus, a need exists to identify efficient and effective means of regulation. This project examines the effectiveness of one health care regulatory program, the Clinical Laboratory Improvement Act Amendments of 1988 (CLIA), in promoting the use of quality tools in the physician office laboratory. This project empirically evaluates regulatory institutions including symbolic regulation, public agency regulation, and private sector accreditation in a competitive market.; Previous findings indicate that deficiencies exist in laboratory quality control systems. The project proposes that differences in organizational structure and values effect both the selection of an appropriate level of regulation by the POL and determine the strength of the laboratory quality system. By controlling for a set of such factors, the project models how the regulatory institutions of CLIA stimulate quality control practices in the POL.; This study provides empirical evidence for a link between quality commitment, laboratory size, and perception of resource adequacy with the choice of regulatory strategy selected by the POL, as well as evidence that resource adequacy, structure, and emphasis on profitability play a role in determining whether quality control is performed in the laboratory. Constraints on reimbursements, therefore, are expected to result in a reduction of quality control over laboratory testing and a reduction in the quality of testing. Controlling for culture and organizational values, regulatory strategy is significant predictor of performance, with the interesting finding that accrediting agencies operating in a competitive market are effective at producing quality control, while public agency regulation is not.; These finding suggest that the Coase theorem regarding welfare maximization through markets holds for the market for regulation. When markets are created for externalities, such as the opportunity costs of regulatory compliance, welfare is maximized. An appropriate consideration, therefore, would be to place public agencies in a "steering role," setting overall policy for regulation and leaving the mechanics of regulation to private sector accrediting agencies. |
