Who is holding whom accountable for quality?

The debate over accountability for managed care quality is occurring everywhere, from Congress and state legislatures to courtrooms and boardrooms. This paper reviews a variety of today's techniques for holding managed care answerable for quality, ranging from those grounded in the law to more market-based approaches, including accreditation and commerce in data about plan performance. Today, there is some dissonance between purchasers' rhetoric about quality and their actual buying behavior. Eventually the discussion of accountability for quality may really be joined when the baby boomers become the consumers of this system and not just its financiers.