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The 'Growth Disease' in American Institutional Medicine

Barry S. Bader
JAMA. 1982;248(2):173. doi:10.1001/jama.1982.03330020019018.
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To the Editor.—  Dr Albert Miller, writing on "The 'Growth Disease' in American Institutional Medicine" (1982;247:469), pins the blame for hospitals' "fiscal chaos" on unrestrained, fiscally irresponsible expansion of facilities and services, commandeered by "growth-oriented administrators" and sanctioned by "strikingly passive governing boards."Dr Miller implies that the growth of medical institutions is responsible for escalating health costs. He ignores other, equally important factors, such as an aging population that demands more services, increased intensity of services, long-overdue increases in nursing salaries, and overall inflation in energy and interest costs.Dr Miller's concluding argument, for stronger institutional leadership by trustees and greater involvement by physicians, is substantially correct, but not for the reasons he ascribes.Based on consulting relationships with many hospitals, it is my observation that when it comes to expanding services, members of the medical staff are often leading advocates for new technology, facilities, and services. The much-publicized


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