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Priorities in Oregon-Reply FREE

Elliott Fisher, MD, MPH; H. Gilbert Welch, MD, MPH; John E. Wennberg, MD, MPH
JAMA. 1992;268(10):1268-1268. doi:10.1001/jama.1992.03490100061023
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In Reply.  —As stated in our article, we agree with Dr Caper about the importance of modifying the implementation of constraints on the local bed supply based on detailed knowledge of local conditions. We also recognize that different hospital utilization patterns are observed in areas of greater poverty. We question, however, the degree to which the overall hospitalization rates in poverty areas are determined by morbidity levels.The study cited by Caper is most consistent, in fact, with the hypothesis that it is the lack of insurance and the lack of adequate access to primary care services, not morbidity, that are the major predictors of higher hospital-use rates among the poor.1 First, Billings and Hasselblad1 found similar rates of admission across income levels for conditions in which illness determines the need for hospitalization, such as acute myocardial infarction and hip fracture. Second, the relationship between admission rates and

REFERENCES

Billings J, Hasselblad V. A Preliminary Study: Use of Small Area Analysis to Assess the Performance of the Outpatient Delivery System in New York City . Lebanon, NH: The Codman Resarch Group; 1989;.
Evans RG.  Tension, Compression and shear: directions, stresses, and outcomes of health care cost control. J Health Polit Policy Law . 1990;;15:101-128.
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief. JAMA . 1987;;257:220-224.
Brook RH, Ware JE, Rogers WH et al.  Does free care improve adults' health? results from a randomized controlled trial. N Engl J Med . 1983;;309:1426-1434.

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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

Billings J, Hasselblad V. A Preliminary Study: Use of Small Area Analysis to Assess the Performance of the Outpatient Delivery System in New York City . Lebanon, NH: The Codman Resarch Group; 1989;.
Evans RG.  Tension, Compression and shear: directions, stresses, and outcomes of health care cost control. J Health Polit Policy Law . 1990;;15:101-128.
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief. JAMA . 1987;;257:220-224.
Brook RH, Ware JE, Rogers WH et al.  Does free care improve adults' health? results from a randomized controlled trial. N Engl J Med . 1983;;309:1426-1434.
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