Figure 1

Divergent models of regulating medical competence: performance-based (market-regulated) vs. rules-based (top-down) systems . The market-based model, shown at left, proposes (i) to regulate medical workforce numbers through demand (i.e., the effects of institutional reputation and performance management on attracting patients, as shown at bottom left) for agreed evidence-based and cost-effective treatments, rather than through restricting provider supply as at present (top right); and (ii) to maintain the safety and quality and quality of medical work through employer- and/or insurer-led audit of relevant clinical indicators (top left) rather than relying upon adherence to centrally-administered educational programmes as currently practised (bottom right).