Britain's National Health Service is taking a page from the Michelin Guide.
It now publishes star ratings for hospitals, much as the French guide ranks hotels and restaurants. But the medical evaluations give far more weight to quick service than to the quality of the food.
The rating system is the latest of several steps intended to tone up a healthcare system that serves everyone but often makes them wait months or years for non-emergency treatment.
Concern about care has been around for years, but only recently have physicians and patients banded together to seek change.
"We don't have the same ethos of demanding the best care," said Gordon McVie, M.D., of the Cancer Research Campaign. "We've been spoon-fed for so long, people assume they're getting the best care."
While some Americans look toward the universal healthcare Britain already has, Britons are trying to make that system serve them better.
General life expectancy is about the same in both countries, 76 years, but for those who become ill, the prospects diverge.
British cancer patients die sooner than Americans and other Europeans. Such differences have been known for years, but now British doctors are publishing scientific articles that focus on the statistics and urge improvements.
The star system introduced at the end of June is designed to identify hospitals that need to do better-and prompt their patients to demand it.
"Information is a lever for change and a spur to improvement," said Virginia Bottomley, secretary of state for health.
Even so, one-star hospitals will not lose patients. Britons cannot shop around for care. They go to their nearest National Health Service hospital.
Physicians believe patients with serious illnesses such as cancer and heart disease should be cared for by experts, not their family doctors, as is often the case.
A group of cancer specialists issued a report in June calling for a major overhaul of cancer treatment to make sure every patient is treated by a specialist at a cancer center.
Fewer than 40% of cancer patients now are seen by specialists. A general surgeon rather than a breast-cancer expert may operate on a woman with a breast lump.
"We're first-class for primary care, but when it comes to cancer care, you get better results in the States," said Karol Sikora, M.D., a cancer specialist at Hammersmith Hospital in London. "It's the speed at which (American doctors) move, the quality of treatment and the aggressiveness with which they approach cancer."
The call for more cancer specialists in Britain comes at a time when the trend in the United States is just the reverse, toward fewer specialists and more general practitioners.
In Britain, a patient needs a referral from his personal physician to see a specialist. A similar system is being considered in the United States as a means of reducing costs.
Harmon Eyre, M.D., chief medical officer of the American Cancer Society, said the United States has one of the world's highest cancer-survival rates mainly because of improvements in early detection and treatment.
"When you turn around and ask why a country like Great Britain has not had the same improvement, we get into speculation," Dr. Eyre said. "My answer is that they do not have as many cancer specialists and the level of treatment is not as good."
The five-year survival rate for women with breast cancer is about 60% in Britain, 70% in the rest of Europe and 80% in the United States.
For small-cell lung cancer, less than one-third of British patients will survive for two years, compared with nearly half of those in the rest of Europe and in the United States, according to a study in Manchester.
About 40% of bowel-cancer patients in Scotland survive for five years, compared with almost 60% of Americans, the Cancer Research Campaign reported.
Doctors say the situation is similar for other diseases.
"We've been pushing for more cardiologists for years," said Douglas Chamberlain, M.D., former president of the British Cardiac Society.
He said the United States has nearly 10 times more heart specialists than Britain in proportion to population.
Because of fewer tests and preventive treatments, plus year-long waiting lists, 75% of Britons who need heart surgery require triple bypasses by the time they get into the hospital, said Stephen Westaby, M.D., a heart surgeon at Oxford University.
Those who seek radical change in the system say only public demand can bring it about.
"Americans are far ahead of us in terms of organizing and campaigning," said Carolyn Faudler of Breast Cancer Care, a support group for patients. "It makes me fed-up."
Ms. Faudler is helping launch Europadonna, a movement for quality care modeled after the National Breast Cancer Coalition in the United States.
"Brits are becoming more assertive," she said. "Women are starting to speak up. Women are starting to complain and say we are not getting a good enough deal. And doctors are joining us, too."