The history of public regulation of the private market in health care dates back many years — at least as far as the Act for regulating private madhouses in 1774. Since that time a wide range of measures designed to control private entrepreneurs and the services and institutions for which they are responsible has evolved. They cover technical matters relating to dangerous drugs, fire precautions and planning requirements, as well as staffing levels and so on. The most important piece of legislation in this field, however, is the 1975 Nursing Homes Act and its subsequent amendments. This paper evaluates the adequacy of this Act as the primary means of monitoring and inspecting the expanding private market in health care.