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In the United States, CME is developed by organizations accredited by the ACCME or state authorities. These include universities, hospitals, publishing companies, insurance companies, medical education companies and even pharmaceutical companies. There are currently about 2,500 accredited CME providers in the U.S.The ACCME's function is not to certify or provide CME activities, but rather accredit, regulate and monitor these accredited organizations who create and provide CME activities (a.k.a. CME providers or sponsors). These entities are rigorously reviewed and must meet and comply with what are known as the ACCME's Essential Areas and Policies, as well as other stringent regulations, in order to maintain accreditation and ability to give credits. In other countries or regions, such as Europe, CME is primarily created and controlled by national medical authorities, societies, and other recognized academic and scientific institutions and organizations. As mentioned earlier, the EACCME's function is to establish European-wide standards, harmonize and improve the quality of medical care and facilitate credit exchange among European countries. They do not accredit organizations to provide CME activities in the same sense as in the U.S., but rather certify activities for European credit, usually once an activity is certified by a national authority or if a national authority does not exist.