The author discusses variations in quality of care, how quality of care can be measured, and what should be done to preserve quality of care. The science of measuring and improving quality must be enhanced, and changes in government policies and programs that affect quality rigorously evaluated. Efforts to make information about the level of quality in health care plans available to the public should be expanded, and quality-enhancing behavioral changes should be fostered by both the providers and purchasers of care. Policies to improve the efficiency and effectiveness and quality of the health care system ought to be developed and implemented. In particular, there must be a concerted effort to get information on quality of care out into the marketplace, so that cost alone will not drive decisions about changes in the health care system.
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