The reference hospitals of the Peruvian Ministry of Health serve patients with complex pathologies. Quality care involves not only good treatment, warmth and humanism in care, but also material resources and real capacity to solve problems. Unfortunately, the reality of the hospitals of the Peruvian Ministry of Health is far from the recommended quality standards, with notable deficiencies in their problem-solving capacity due to the lack of diagnostic aid methods, lack of equipment, and flaws in the acquisition of medications and supplies. It is inadmissible for a referential level hospital not to have imaging studies such as magnetic resonance, nuclear medicine, angiography, immunohistochemistry, molecular biology and genetic studies, among others. This article presents some of the problems encountered in daily practice from the perspective of the author as a healthcare provider and reviews the findings of the quality of care evaluation conducted by the Comptroller General of the Republic in 2018 in reference hospitals. Some immediate measures of action are proposed, emphasizing the need to immediately address the lack of infrastructure and resolution capacity for diagnosis and treatment, as well as to promote public tenders for hospital managers that would allow a transparent and meritocratic exercise not subject to political vagaries.