Mandatory forms of quality assurance should be progressively introduced, for instance: peer-review activities, assessment of professional performance, and continuous medical education. Such mechanisms could be linked to the ending medical licences being awarded “for life” in favour of a system of licence renewal (as is typical in other countries). For example, medical school fees paid by students could be raised but then partially reimbursed for those who subsequently work in the NHI system or, similarly, a system of bonded scholarships could be established.