A vision of quality in health care delivery.

Empirical evidence is thin, so one must reply on informed judgment, common sense, and theory when describing a high-quality health plan. Using this approach, a high-quality health plan would be characterized by excellence in the following areas: physician selection and development; health improvement; information systems; continuous quality improvement; cooperation with health care purchasers; alignment of financial incentives and appropriate capitation; and patient involvement. High-quality health plans would be nurtured by a national context in which medical education recognizes managed care and quality measurement, risk-adjusted premiums are the norm, competition is managed, and government has a limited role.