Nearly every major policy initiative in medical care relates to one of three major themes: cost, quality, or access. Some policy-makers emphasize runaway costs and seek new methods of restricting expenditures. Others focus on lack of access to medical care, especially for the uninsured. Another set of concerned individuals advocates methods for providing better quality medical care. Since these themes are not readily divisible, it is reasonable to pay some attention to quality in a symposium issue on costs and access.

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