In addition to the marked decrease in hospital use, there was concomitant decrease in the use of all services (visits, laboratory, x-ray) during the same years. Since we provided organized ambulatory services, we were not surprised to see a drop in hospital use. However, serial reductions in use and expenditures for ambulatory services of the magnitude described in this publication have not, to our knowledge, been reported.
Situational, social, and psychological problems do make up a large percentage of the total problems seen in comprehensive primary care; however, it is unlikely that such decreases in use and expenditures could have been due solely to changes in the approach to caring for these problems.
We would agree with Dr Paul that awareness and competency in treating emotional problems is fundamental to both improving the quality of care and controlling expenditures for care. Physicians will vary in their interest and