Abstract
In attempting to assess the contributions of medical care to health improvements, the goals of care must first be addressed. The saving of lives in acute life-threatening emergencies is an important such goal, but it represents a very small component of the total medical effort: while lives are saved, the sum of such saving is too small to have a measurable impact on the life expectancy of an entire population. A much larger effort is devoted to preventive or curative measures, and these do have a large and measurable effect on the life expectancy of the population as a whole. An even greater component of medical effort is devoted to improving the quality of life, or more accurately, to preventing or to minimizing the poor quality of life associated with chronic disease: to the relief of pain, disfigurement, and disability.