By 1990 the aggregate supply of physicians in the United States is likely to exceed the population's requirements by 10 percent or more. State and regional aggregate and specialty-specific surpluses may be more extreme. Since the demand for physician services appears to be determined to a significant degree by the supply of physicians, the number of physicians who can maintain financially viable practices in a region is not likely to be limited effectively by the normal market interaction of supply and demand. Excessive physician supplies may, however, have a number of deleterious effects, including rapid escalation of health care costs, fragmentation of patient care, and a decrease in the quality of patient care.

In this Article, the authors review the potential effectiveness of a number of policy interventions that might be employed to optimize physician supplies in areas of excess. They evaluate the following alternatives: (1) a limit on the number of medical school graduates; (2) control of physician residencies by number and by specialty; (3) creation or implementation of incentive policies; (4) control by hospitals—indirectly by limiting the number of beds, or directly by denying staff privileges; (5) widespread development of HMOs; (6) direct employment by the federal government of the majority of practicing physicians; and (7) creation of certificate of need for physician licensure. The authors conclude that, at least in the short term, certificate of need'for physician licensure is the alternative that shows the greatest promise of enabling the number and specialties of physicians providing patient care in areas facing a physician surplus to be managed in such a way that the populations of such areas can obtain adequate medical care at a reasonable cost.

In Harris v. McRae, the recent case in which the U.S. Supreme Court upheld the constitutionality of the Hyde Amendment, the Court for the first time was asked to consider whether antiabortion legislation respects the establishment of religion or violates the free exercise thereof. The Court held that the Amendment did not effect an establishment of religion, and found that the plaintiffs lacked standing to raise the free exercise argument.

The writer explores the questions raised, agreeing with the Court's disposal of the establishment argument. He does find considerable.validity in the free exercise challenge, but concludes that the Court as presently constituted is unlikely to accept it. In addition, he believes that the Court, in its treatment of both arguments, either ignored or improperly dis tinguished earlier cases that supported the plaintiffs.

The American health care delivery system currently suffers from a variety of problems; among the most intractable of these is a maldistribution of health care services. This Note focuses on two aspects of this problem: unnecessary hospital beds, and medically underserved populations. The Note also discusses the related issues of hospital cost inflation and inefficient use of limited resources. It then examines the current statutory remedies for these problems, and subjects their effectiveness to a two-tiered test. The Note concludes that the existing mechanisms, while partially effective, ultimately result in a fragmented, uncoordinated, and unsuccessful health care regulatory system. Moreover, the Note suggests not only that the existing statutes fail to solve the problems they were enacted to correct, but that they actually add to health care inflation and complicate health planning by subjecting the entire health care industry to uncertainty. This Note proposes a comprehensive regulatory approach that will resolve health care imbalances in a manner that avoids the shortcomings inherent in the present system.

Psychiatric experts are now called more frequently than in the past to testify in courtroom proceedings. Often, however, their testimony leads, to non-productive "battles of the experts." This Note examines various plans that seek to minimize the conflicts in expert testimony due, not to legitimate psychiatric disputes, but rather to inaccurate or biased testimony offered by one or both psychiatrists. It concludes that either of two plans would be effective: the first provides for a panel similar to existing medical malpractice tribunals; the second mandates court appointment of an inde pendent expert to testify in addition to those called by adversaries.