Health care expenditures are a major concern of governments in Canada and the United States. Over the past 40 years, a variety of approaches have been used to control costs, including global budgeting, managed competition, cost sharing, and pay for performance. Policy makers recognize that physicians play a central role, with some estimates suggesting that physicians control 80% of health expenditures.1
Most policy recommendations therefore acknowledge the importance of physicians in implementing changes to health care organization. Fundholding and various managed care organizational structures are examples of policy mechanisms that seek to control physician-driven health expenditures. Initiatives like the American College of Physicians' “High Value, Cost Conscious Care” program2 and the Archives of Internal Medicine ’s “Less Is More” series3 seek to educate and engage physicians in appropriate resource management. The American Board of Internal Medicine Foundation and its partners go one step further with “Choosing Wisely.”4 These initiatives aim to eliminate wasteful spending, which has been estimated at 10% of the US health care budget, or $210 billion annually.5,6
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