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Quality assurance and quality improvement are two highly visible indicators of the significant forces that are remolding the American healthcare delivery system. Edward K. Jeffer reviews the current status of these disciplines and makes projections on how they will affect the structure and practice of healthcare in the next century. Some speculations are presented as to why the future appears so bleak to so many healthcare providers. A more optimistic outlook is suggested, and the key role of quality assurance professionals is emphasized.