clinicians and service managers should be encouraged to change practice towards better and safer care through a mix of educational measures data collection and disclosure requirements with feedback on performance provided back to clinicians managers and users the celebration of good practices or encouragement of hospital and clinician champion roles will also contribute to a quality improvement culture whilst this reform is likely to have protected patients from being referred unnecessarily to physicians private practice or from being seen by exclusively by junior doctors in public hospitals there are reports that it has led to some clinicians dropping parttime practice in public hospitals a review of quality and access indicators before and after the reform should be undertaken although a growing amount of data is becoming available that can be used to monitor quality of care present quality assurance activities are rather controloriented and the available information is not exploited to its full potential