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September 6, 1985, Vol 254, No. 9 >
ARTICLE | September 6, 1985

Cost Containment and the Physician FREE

Marcia Angell, MD
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Reprint requests to New England Journal of Medicine, 10 Shattuck St, Boston, MA 02115 (Dr Angell).


JAMA. 1985;254(9):1203-1207. doi:10.1001/jama.1985.03360090093027
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References

The rapid rise in health care costs is receiving a good deal of attention these days. Proposed responses include the deliberate rationing of expensive medical technologies, such as organ transplantation, and a redirection of our efforts toward preventive care. Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one. I suggest that a major and rapidly growing component of medical costs stems from the widespread application of tests and procedures when they are of no demonstrated benefit and may even be harmful. Identifying and curtailing such unnecessary medical care, rather than rationing beneficial technologies, should be the thrust of cost-containment efforts. Fee schedules should be revised so that they neither encourage nor discourage the use of tests and procedures; we should undertake systematic studies to assess technologies and practices; and we should make every effort to discourage the practice of defensive medicine. The involvement of physicians in rationing is not only premature; it is also inconsistent with our role as advocates for the health of our patients.

(JAMA 1985;254:1203-1207)

REFERENCES

1 +
Leaf A:  The doctor's dilemma—and society's too . N Engl J Med 1984;;310:718-720.
2 +
Aaron HJ, Schwartz WB: The Painful Prescription: Rationing Hospital Care . Washington, DC, The Brookings Institute, 1984;.
3 +
Scitovsky AA:  Changes in the use of ancillary services for 'common' illness , in Altman SH, Blendon R (eds): Medical Technology: The Culprit Behind Health Care Costs ? publication (PHS) 79-3216. US Dept of Health, Education, and Welfare, 1979;.
4 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
5 +
Lundberg GD:  Perseveration of laboratory test ordering: A syndrome affecting clinicians . JAMA 1983;;249:639.
6 +
Martin AR, Wolf MA, Thibodeau LA, et al:  A trial of two strategies to modify the test ordering behavior of medical residents . N Engl J Med 1980;;303:1330-1336.
7 +
Hubbell FA, Greenfield S, Tyler JL, et al:  The impact of routine admission chest x-ray films on patient care . N Engl J Med 1985;; 312:209-213.
8 +
Wennberg JE, McPherson K, Caper P:  Will payment based on diagnosis-related groups control hospital costs ? N Engl J Med 1984;;311:295-300.
9 +
 Coronary Artery Surgery Study (CASS): A randomized trial of coronary artery bypass surgery . Circulation 1983;;68:939-950.
10 +
Dyken ML, Pokras R:  The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;;15:948-950.
11 +
Brott T, Thaliner K:  The practice of carotid endarterectomy in a large metropolitan area . Stroke 1984;;15:950-955.
12 +
Annas GJ:  Prisoner in the ICU: The tragedy of William Bartling . Hastings Center Rep 1984;;14:28-29.
13 +
Rust M:  Key ruling awaited on terminating treatment . Am Med News 1984;;27:1, 29-30.
14 +
Angell M:  The quality of mercy . N Engl J Med 1982;;306:989.
15 +
Suber DG, Tabor MJ:  Withholding of life-sustaining treatment from the terminally ill, incompetent patient: Who decides ? JAMA 1982;;248:2250-2251, 2431-2432.
16 +
Barondess JA:  The health policy agenda for the American people . JAMA 1983;;249:2073-2074.
17 +
Annas GJ: Report of the Massachusetts Task Force on Organ Transplantation . Boston, Boston University School of Public Health, 1984;.
18 +
Austen WG, Cosimi AB:  Heart transplantation after 16 years . N Engl J Med 1984;; 311:1436-1438.
19 +
Evans RW:  Health care technology and the inevitability of resource allocation and rationing decisions . JAMA 1983;;249:2208-2219.
20 +
Gunby P:  Media-abetted liver transplants raise questions of 'equity and decency .' JAMA 1983;;249:1973-1974, 1980-1982.
21 +
Eisenberg L:  Barriers to care . Can J Psychiatry 1984;;29:452-460.
22 +
Levinsky NG:  The doctor's master . N Engl J Med 1984;;311:1573-1575.
23 +
Relman AS:  Assessment of medical practices . N Engl J Med 1980;;303:153-154.
24 +
Boyle JF:  Should we learn to say no ? JAMA 1984;;252:782-784.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Leaf A:  The doctor's dilemma—and society's too . N Engl J Med 1984;;310:718-720.
2 +
Aaron HJ, Schwartz WB: The Painful Prescription: Rationing Hospital Care . Washington, DC, The Brookings Institute, 1984;.
3 +
Scitovsky AA:  Changes in the use of ancillary services for 'common' illness , in Altman SH, Blendon R (eds): Medical Technology: The Culprit Behind Health Care Costs ? publication (PHS) 79-3216. US Dept of Health, Education, and Welfare, 1979;.
4 +
Moloney TW, Rogers DE:  Medical technology: A different view of the contentious debate over costs . N Engl J Med 1979;;301:1413-1419.
5 +
Lundberg GD:  Perseveration of laboratory test ordering: A syndrome affecting clinicians . JAMA 1983;;249:639.
6 +
Martin AR, Wolf MA, Thibodeau LA, et al:  A trial of two strategies to modify the test ordering behavior of medical residents . N Engl J Med 1980;;303:1330-1336.
7 +
Hubbell FA, Greenfield S, Tyler JL, et al:  The impact of routine admission chest x-ray films on patient care . N Engl J Med 1985;; 312:209-213.
8 +
Wennberg JE, McPherson K, Caper P:  Will payment based on diagnosis-related groups control hospital costs ? N Engl J Med 1984;;311:295-300.
9 +
 Coronary Artery Surgery Study (CASS): A randomized trial of coronary artery bypass surgery . Circulation 1983;;68:939-950.
10 +
Dyken ML, Pokras R:  The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;;15:948-950.
11 +
Brott T, Thaliner K:  The practice of carotid endarterectomy in a large metropolitan area . Stroke 1984;;15:950-955.
12 +
Annas GJ:  Prisoner in the ICU: The tragedy of William Bartling . Hastings Center Rep 1984;;14:28-29.
13 +
Rust M:  Key ruling awaited on terminating treatment . Am Med News 1984;;27:1, 29-30.
14 +
Angell M:  The quality of mercy . N Engl J Med 1982;;306:989.
15 +
Suber DG, Tabor MJ:  Withholding of life-sustaining treatment from the terminally ill, incompetent patient: Who decides ? JAMA 1982;;248:2250-2251, 2431-2432.
16 +
Barondess JA:  The health policy agenda for the American people . JAMA 1983;;249:2073-2074.
17 +
Annas GJ: Report of the Massachusetts Task Force on Organ Transplantation . Boston, Boston University School of Public Health, 1984;.
18 +
Austen WG, Cosimi AB:  Heart transplantation after 16 years . N Engl J Med 1984;; 311:1436-1438.
19 +
Evans RW:  Health care technology and the inevitability of resource allocation and rationing decisions . JAMA 1983;;249:2208-2219.
20 +
Gunby P:  Media-abetted liver transplants raise questions of 'equity and decency .' JAMA 1983;;249:1973-1974, 1980-1982.
21 +
Eisenberg L:  Barriers to care . Can J Psychiatry 1984;;29:452-460.
22 +
Levinsky NG:  The doctor's master . N Engl J Med 1984;;311:1573-1575.
23 +
Relman AS:  Assessment of medical practices . N Engl J Med 1980;;303:153-154.
24 +
Boyle JF:  Should we learn to say no ? JAMA 1984;;252:782-784.

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