Public perception of health care needs gives highest priority to spiraling costs with second place to the need for greater availability of health care services. Relatively far down on the list of public priorities is quality. The feeling is, by and large, that what we have is pretty good, and, if only we could afford it more easily and get it more readily, all would be fine. Peer review mechanisms have tended to follow public pressures and expectations and have largely concerned themselves with monitoring patterns of utilization and policing of individual instances of poor care. The problems of manpower and distribution are being approached by numerous proposals aimed at the production of more physicians and other health care personnel primarily to fill needed service roles. It is becoming increasingly evident that the rapid expansion of biomedical knowledge has created a "future shock" situation which demands increasing emphasis on the