Healthcare regulation: past, present, and future.

Excessive regulation has created a formidable barrier for physicians to surmount when treating patients. This article examines the increasing intrusion by regulatory agencies--government and private--into the patient-physician relationship. The authors examine the history of healthcare policy leading to today's highly regulated approach to cost-containment. They trace the development of the emphasis on regulatory controls from 1900 to the present. Further, they examine in detail the specific impact of diagnosis-related groups, utilization review firms, and the Clinical Laboratory Improvement Amendments of 1988 on the patient-physician relationship. Diagnosis-related groups set the hospital administration as monitor of the patient-physician relationship. Utilization review firms insert themselves as another gatekeeper in decisions of appropriateness of care. The Clinical Laboratory Improvement Amendments causes laboratories to close, thereby restricting access to care. The reform movement would respect the patient-physician relationship and remove excessive regulation from this confidential interaction. Regulation after reform would react to outcomes rather than controlling the process of healthcare delivery.