League tables which would allow the public to assess the standard of medical care in individual hospitals will be introduced within five years if the Minister for Health, Mr Cowen, has his way.
Mr Cowen also warned doctors that if they are to continue to regulate the medical profession themselves, their actions will have to become more transparent and they will have to be more accountable.
"If any profession is to hold on to the privilege afforded by self-regulation it must demonstrate that it works. It has to be seen to be effective, accountable and transparent," Mr Cowen told The Irish Times.
"It is the whole question of being transparent. You can't have hidden medicine just like you can't have hidden politics," he said. Doctors are regulated by the Medical Council, elected from their ranks.
Mr Cowen was speaking following revelations in The Irish Times this week that a consultant obstetrician is under investigation following his performance of a large number of Caesarean hysterectomies.
In a separate case, a surgeon in a different hospital was being investigated following an external examination of a number of cases, including two in which patients died.
The case of the consultant obstetrician is being reviewed by colleagues from the Institute of Obstetricians and Gynaecologists at the request of the health board involved. He had been reviewed previously by a group of Irish colleagues, whose report was apparently at odds with an external report written by a British consultant at the request of the health board.
Mr Cowen said there was no clear alternative to professional self-regulation. He said colleagues in a particular discipline of medicine often were best placed to see if a doctor was "adhering to professionally accepted standards".
However, he said, the Irish medical community was a relatively small one. Self-regulation was more difficult when a doctor was investigated by colleagues who might well be known to them.
"In fairness to everybody I am not saying that they would not be able to carry it out, but having an external element is important. Of course, the general public would be very mindful of there being an external component, it is a fact of life. I am not saying that a colleague could not do it, but it would be fairer and more transparent the other way."
He said that when problems arose in the medical profession the difficulty was that the response was reactive rather proactive when they involved complaints or lawsuits. "It is ideally better to have a proactive approach," Mr Cowen said, adding that hospitals must introduce clinical audits, measuring performance and risk-management.
He said consultants' contracts obliged them to participate in clinical audits, but it had been slow to get off the ground. Clinical audits were conducted in a number of hospital at present, he said, but they failed on accountability because they were done in secret.
Before league tables were introduced, he said, all hospitals would have to become involved in this area. Some had begun, but others were only beginning to get their records on computer.
Next year, he said, the Department would spend £300,000 on an initiative to encourage use of information technology in cancer surgery, obstetrics/gynaecology and anaesthetics.