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04/09/99 13:40 FAX 002 EXECUTIVE SUMMARY Quality First: Better Health Care for All Americans Every day, millions of Americans receive high-quality health care that helps to maintain or restore their health and ability to function. Skilled physicians, nurses, and other health care practitioners offer expert compassionate care to people in need. High-caliber hospitals, nursing homes, and other health care institutions provide care to patients in need of acute and chronic care. Academic health centers educate and train new generations of health care practitioners and house many of the finest scientific minds who advance the science of health care. Federal, State, and local governments, private employers, labor unions, and others purchase health care coverage for millions of American families, offering security and peace of mind. And public and private quality oversight organizations work to make sure that the care provided is of the highest quality in the world. A central goal of quality improvement is to maintain what is good about the existing system while focusing on the areas that require improvement. While most Americans receive high-quality care, too many patients receive substandard care. Quality problems include wide variation in health care services, underuse of some services and overuse of others, and an unacceptable level of errors. Efforts by leaders of the health care professions, the health care industry, major employers, and State and Federal agencies have significantly improved our ability to identify quality problems and begin to address their causes. What is needed now is a national commitment to quality improvement that begins with the President and the Congress and extends to every level of the health care industry. In seeking to improve the quality of care for all Americans, we cannot forget that there are more than 41 million Americans who live day to day without the security of health insurance. For them, access to quality care often is severely limited. Addressing this issue is critical to improving the health and functioning of all who live in our communities. 1