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The American health care system offers millions of patients access to health care provided by highly skilled, committed professionals and first-rate health care institutions, as well as the advantages of the latest innovations in clinical research, technology, and treatment. At the same time, the system is marked by serious and pervasive deficiencies in quality. Quality problems affect all patients, regardless of age, gender, financial resources, or race. In addition, quality problems cut across the delivery system, and are not the result of any single financing or payment arrangement. Quality deficiencies result in increased mortality and morbidity and in failure to alleviate conditions that cause pain and disability, leading to a lower quality of life, a less productive workforce, and billions of dollars in unnecessary costs.