In Reply: We are encouraged that Dr Herzlinger and Mr Falit value the importance of professionalism. We agree that increased competition with transparency will promote professional ethics. Especially in a competitive marketplace, because of information asymmetry, uncertainty, and the need for a trusting relationship between physician and patient, health care will always need to rely on physicians acting in their patients' best interests.
We did not express opposition to health care competition per se, but rather to a specific form of competition core to the “consumer-driven” approach that encourages patients to shop for discrete health services to find the best match of quality and costs. The biggest challenge in health care today is to improve the value of coordinated care for patients with multiple and complex illnesses, requiring a relationship over time and a system of care. Indeed, we applaud efforts to promote organized systems of care competing for the allegiance of patients and held accountable to public and private payers for quality and cost performance. We are concerned that “retail shopping” by specific (usually procedure-based) service will inevitably lead to compromise in professional duties to patients, even if that is not the intent.