The National Health Service (NHS) is embarking on an ambitious new program to measure the quality of health care within the service. In the past, quality has been measured in a piecemeal way, and the results have rarely, if ever, been made available to the public. In the USA, researchers, government, and the purchasers of health care have twenty-five years of experience in assessing healthcare quality. The authors believe that some lessons learned in America are relevant to the task at hand for the NHS. Contrast this situation with the NHS, which was created as a publicly-financed system available to the whole population. In general, no charges are generated, so there are no routinely collected data on each patient encounter.
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