This report is concerned with efforts to assure quality in medical care, focussing on quality assurance efforts affecting care provided by doctors and hospitals (and to a lesser extent nursing homes). The study examines quality assurance in Sweden, Federal Republic of Germany, Belgium and England as these represent a range of approaches to health care system organisation. The study begins by describing the health care delivery and financing systems of the countries; it then proceeds to examine the means they are using or developing for medical care quality assurance; it concludes by reflecting on the future of health care quality regulation in Europe. The study is based on interviews with nearly 30 experts on the relevant health care systems.