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Health care services are being evaluated and redefined.Terms such as "medically necessary" and "comprehensive" are being supplanted by "core", "basic" and "optional." Quality-of-care concepts and analysis can assist decision making about which services should be insured, core services. A service is more likely to remain or become insured and core to the system if it satisfies the key dimensions of high quality: effectiveness, appropriateness, efficiency, patient acceptance and safety. Quality of care, combined with ethical and economic considerations, provides an analytic framework for deciding whether services should be insured.