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The Future of Health Care: Military Model? Canadian Cost Cutting?

Roger E. Miller
JAMA. 1990;264(15):1944. doi:10.1001/jama.1990.03450150042012.
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To the Editor.—  Dr Bronow1 and the National Organization of Physicians Who Care are properly concerned about the looming changes in physician payment and practice patterns. Many of their fears, though, may not be wholly justified. We need not go as far as Saskatchewan to find an example of a universal-enrollment, managed care system that has served physicians and patients admirably well.The US military medical system provides comprehensive, cradle-to-grave medical care, with no out-of-pocket cost to the patient, to over 9 million people. At a cost of about $1444 per beneficiary,2 the system is also more cost-efficient by 28% than the US per capita health care cost and is nearly as cost-efficient as the Canadian and German systems.3 Poor, elderly, and chronically ill patients are all cared for. While staffing fluctuations occasionally lead to temporary curtailment of services in military hospitals, the Department of Defence—sponsored insurance


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