The quality of health care in the United States is a major national concern. The U.S. has a limited system for tracking the quality of care, with little systematic evidence available. The Institute of Medicine defines quality as the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality can be evaluated based on structure, process, and outcomes. Technical process quality refers to whether care is provided skillfully and whether the right choices are made in diagnosing and treating patients. The review of the academic literature found that there is more experience with measuring processes of care than outcomes. The review found that there are large gaps between the care people should receive and the care they do receive, regardless of the type of care—preventive, acute, or chronic. For example, in preventive care, about 50% of people received recommended care. In acute care, 70% received recommended care, while 30% received contraindicated care. For chronic conditions, 60% received recommended care, while 20% received contraindicated care. These findings suggest that there is significant room for improvement in the quality of care. The review also found that managed care is not necessarily responsible for poor quality, as studies show mixed results. The review highlights the need for a comprehensive system to assess the quality of care in the United States, including how quality varies by population subgroups and over time. The authors conclude that the quality of health care in the United States varies among hospitals, cities, and states, and that there is a need for a systematic strategy to monitor and improve the quality of care.The quality of health care in the United States is a major national concern. The U.S. has a limited system for tracking the quality of care, with little systematic evidence available. The Institute of Medicine defines quality as the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality can be evaluated based on structure, process, and outcomes. Technical process quality refers to whether care is provided skillfully and whether the right choices are made in diagnosing and treating patients. The review of the academic literature found that there is more experience with measuring processes of care than outcomes. The review found that there are large gaps between the care people should receive and the care they do receive, regardless of the type of care—preventive, acute, or chronic. For example, in preventive care, about 50% of people received recommended care. In acute care, 70% received recommended care, while 30% received contraindicated care. For chronic conditions, 60% received recommended care, while 20% received contraindicated care. These findings suggest that there is significant room for improvement in the quality of care. The review also found that managed care is not necessarily responsible for poor quality, as studies show mixed results. The review highlights the need for a comprehensive system to assess the quality of care in the United States, including how quality varies by population subgroups and over time. The authors conclude that the quality of health care in the United States varies among hospitals, cities, and states, and that there is a need for a systematic strategy to monitor and improve the quality of care.