Cost Containment and Quality Care

To the Editor.  —In his review of Common Diagnostic Tests: Use and Interpretation, Dr Boisaubin¹ says, "Creating new standards for excellent, cost-effective medical care may be the greatest challenge to the practice of American medicine in the next decade. The greatest undeclared benefit of this (seminal) work lies in its potential to increase cost-effectiveness in all physician testing behavior. This manual should... find its way into the labcoat pocket of every thinking physician."The first question every thinking physician should ask is whether he can lawfully consider costs in reaching his professional decisions.I have never set foot in a law school but I learned the answer from a suit I brought against the local health commissioner and also, in effect, from a private ruling by the commissioner of the agency that licenses physicians. There is nothing whatever in New York law that permits a physician to consider costs;