Improving a medical care system requires an understanding of input and output functions and how they are achieved. Changes should be preceded by the establishment of a data system that will produce accurate measurements before and after change so that evaluation is possible. An initial approach, once measurement techniques have been established, would be to conduct a pilot study on an isolatable portion of the system. This might be beneficial when dealing with large urban systems but, perhaps, unnecessary for smaller rural or suburban systems. Changes will depend upon public pressure for improvement and availability of funds to meet the costs of preserving life and good health.