particular attention should be paid to targeting investment towards populations care segments and regions which lag behind quality improvement measures must be implemented at all level and their impact on process and health outcomes better monitored payforperformance arrangements could be based on improvements in these health outcomes rather than on process measures or the occurrence or avoidance of rare events quality improvement initiatives should also prioritise further modernisation of health information systems in order to integrate health care data and support continuity and coordination of care for patients to accelerate improvement in health outcomes and close the gaps in key health indicators greater public funding is likely to be required