Medical audit: in need of evaluation.

In 1976, two years after the introduction of mandatory quality assurance in the United States healthcare system' and at a time of growing debate about the benefits of that investment,2 Charles Phelps, an American economist, wrote: "The evidence used to justify these various regulations of quality has been, to be generous, sparse. The primary justification for many of these programs is that the present state of affairs is scandalous, so that change must lead to improvement. While not necessarily quarrelling with the premise, the conclusion is unwarranted. It therefore seems appropriate to begin to evaluate the evaluators, to develop a framework with which one could assess the gains to society from undertaking a quality assurance program of one type or another."'