Issues and challenges in quality assurance of health care

In this paper I review the health care crisis in the United States and conclude that fundamental changes must be made. I then present: (1) an organizational approach that might be encompassed in President Clinton's program for health care reform; (2) my "dream" of a national quality improvement system for reform, based on The Netherlands Model; and (3) a suggestion that strengthening primary care will be the key to the success of this reform in the coming years.