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An excellent article, Bob. It reminds me of the problems I had working for the Victorian Work Health system. The aim of the insurance company (=health care provider) which employed me was to make money for its share holders; my aim was to improve the health and well-being of injured workers. Meeting my employer's aim usually meant getting people back to work at any cost to them, meeting my aim often meant keeping them away from work for long periods of time, sometimes permanently. Measures of "quality control" which were instigated by the insurance company were really measures of "quantity control" - how many people could be put through the system in a day, rather than how many people improved in health over a given time. The problem was that the people making the final decisions were actuaries, accountants and business entrepreneurs. - Rosemary ------------------------------------------------------------------------------ Rosemary Lyndall Rosemary from DownUnder _--_|\ Clinical Neuro-psychologist [log in to unmask] Perth / \ Perth, Western Australia [log in to unmask] -->\_.--._/ ---------------------------------------------------------------------------v--