This chapter discusses the three cornerstones of health care delivery: cost, access, and quality. It outlines factors that drive rising health care costs in the U.S. such as third-party payment and practice variations. Regulatory approaches to containing costs like price controls and competitive approaches like utilization management are examined. The key dimensions of access to care and indicators used to measure access are reviewed. Quality is discussed in terms of assurance and assessment using frameworks like the Donabedian Model of structure, process, and outcomes. The Affordable Care Act aims to address costs, access, and quality through provisions around insurance, payment reform, and quality improvement.