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Editor's note: This was adapted with permission from the consensus report Outcomes-Based Compensation: Pay-for-Performance Design Principles from American Healthways. Go to www.rewardingquality.com to read the full report or for more information. Americans think their healthcare is the best in the world. The large biomedical research enterprise produces a steady output of new pharmaceutical, medical, and surgical products and procedures. Technical diffusion is rapid, giving the United States an incredibly resource-rich healthcare system.