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The author reflects on quality of health care in the U.S. and Great Britain and the star rating system. He remarked that the health care systems have been searching for ways of how to improve quality of care, including the use of financial incentives like the pay for performance arrangements. He also commented on the study conducted which aims to evaluate the effects of the star rating system involving acute hospital trusts.

Commentary. Observes the United Kingdom National Health Service (NHS) plan of quality assessment based on 81 proposed quality indicators; Three key issues; Goals of NHS; The differences in approach to assessment of the use of grommet (tympanostomy tube) surgery in children; Use of quality assessments based mostly on data from health-care providers; The view that doctors should consider quality assessment an important professional responsibility; The lessons which can be learned.