Health Care:

Limited State Efforts to Assure Quality of Care Outside Hospitals

HRD-90-53: Published: Jan 30, 1990. Publicly Released: Mar 2, 1990.

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Pursuant to a congressional request, GAO assessed state requirements relating to quality assurance for health care delivered by both freestanding providers and health maintenance organizations (HMO), focusing on: (1) licensing, inspection, and enforcement for 16 types of freestanding providers; and (2) inspection and enforcement activities for health maintenance organizations.

GAO found that: (1) states did not license or otherwise regulate most of the 16 types of freestanding providers; (2) state officials cited appeals processes and the lack of intermediate sanctions as impediments to imposing sanctions; (3) state officials expressed concern about the adequacy of their oversight and licensing efforts; (4) while most states received complaints regarding freestanding providers' quality of care, only half had systems for resolving such complaints; (5) states' plans for expanding licensing requirements to unlicensed providers are limited; and (6) while 22 states had on-site inspection programs for HMO, only 2 states levied sanctions against HMO from 1985 through 1987.

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