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July 28, 1993, Vol 270, No. 4 >
ARTICLE | July 28, 1993

Three Battles to Watch in the 1990s FREE

David M. Eddy, MD, PhD
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Reprint requests to Skyline Route, Box 32, Jackson, WY 83001 (Dr Eddy).


JAMA. 1993;270(4):520-526. doi:10.1001/jama.1993.03510040124050
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References

HOWEVER the debate on national health care reform comes out, and whatever strategies are eventually used to achieve the seemingly incompatible goals of providing universal access, improving quality, and controlling costs, one thing is certain: The day-to-day decisions of those who actually provide health care will be put under ever-increasing stress. Reform will not solve the problems that have been causing the pressure on physician decision making over the last decade; it will rely on further pressure to solve the problems.

We know this will occur for several reasons. Begin with the fact that of the three main goals of health care reform— access, quality, and cost—the driving force is cost. To be more precise, the driving force is the rate of increase in costs—the fact that health care costs have been rising at about twice the rate of inflation. It is this feature of health care that has transformed

REFERENCES

1 +
Congressional Research Service.  Analysis of national health expenditure data.  In: Committee on Ways & Means, US House of Representatives. Health Care Resource Book, April 16, 1991 . Washington DC: Congressional Research Service; 1991;.
2 +
Eddy DM.  The challenge. JAMA . 1990;;263:287-290.
3 +
Institute of Medicine. Assessing Medical Technologies . Washington, DC: National Academy of Sciences; 1985;.
4 +
Akiyama T, Pawitan Y, Greenberg H, Kuo C, Reynolds-Haertle R.  Increased risk of death and cardiac arrest from encainide and flecainide in patients after non-Q-wave acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1991;;68:1551-1555.
5 +
Beck R, Cleary P, Andreson Jr M, et al.  A randomized controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med . 1992;;326:581-588.
6 +
Eddy DM.  Practice policies—guidelines for methods. JAMA . 1990;;263:1839-1841.
7 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
8 +
Sox HC, Woolf SH.  Evidence-based practice guidelines from the US Preventive Services Task Force. JAMA . 1993;;269:2678.
9 +
Mandel J, Bond J, Church T, et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med . 1993;;328:1365-1371.
10 +
Winawer S.  Colorectal cancer screening comes of age. N Engl J Med . 1993;;328: 1416-1417.
11 +
Selby J, Friedman G, Quesenberry C Jr, Weiss N.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med . 1992;; 326:653-657.
12 +
Davis G, Balart L, Schiff E, et al.  Treatment of chronic hepatitis C with recombinant interferon alfa: a multicenter randomized, controlled trial. N Engl J Med . 1989;;321:1501-1506.
13 +
Seeff LB, Buskell-Bales Z, Wright EC, et al.  Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med . 1992;;327:1906-1911.
14 +
Mettlin C, Lee F, Drago J, Murphy GP.  The American Cancer Society National Prostate Cancer Detection Program: findings on the detection of early prostate cancer in 2425 men. Cancer . 1991;;67:2949-2958.
15 +
Baker L.  Breast Cancer Detection Demonstration Project: five-year summary report. CA . 1982;;32:194-225.
16 +
Miller A, Baines C, To T, Wall C.  Canadian National Breast Screening Study, I: breast cancer detection and death rates among women ages 40 to 49 years. Can Med Assoc J . 1992;;147:1459-1476.
17 +
Office of Technology Assessment, US Congress. Report on Assessing Efficacy and Safety of Medical Technologies . Washington DC: Office of Technology Assessment; 1978;.
18 +
Fleming C, Wasson J, Albertsen P, Barry M, Wennberg J.  A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA . 1993;;269:2650-2658.
19 +
Eddy DM.  Uncertainty, outcomes, and the quality of medical care.  In: Proceedings: Cornerstones of Health Care in the Nineties: Forging a Framework of Excellence . September 16-18, 1990;; Hot Springs, Va. Sponsored by the Joint Commission on Accreditation of Healthcare Organizations and The Prudential Insurance Company of America.
20 +
Eddy DM.  Applying cost-effectiveness analysis: the inside story. JAMA . 1992;; 268:2575-2582.
21 +
Lundberg G.  American health care system management objectives: the aura of inevitability becomes incarnate. JAMA . 1993;;269:2554-2555.
22 +
Eddy DM.  Designing a practice policy: standards, guidelines, and options. JAMA . 1990;;263:3077, 3081, 3084.

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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 +
Congressional Research Service.  Analysis of national health expenditure data.  In: Committee on Ways & Means, US House of Representatives. Health Care Resource Book, April 16, 1991 . Washington DC: Congressional Research Service; 1991;.
2 +
Eddy DM.  The challenge. JAMA . 1990;;263:287-290.
3 +
Institute of Medicine. Assessing Medical Technologies . Washington, DC: National Academy of Sciences; 1985;.
4 +
Akiyama T, Pawitan Y, Greenberg H, Kuo C, Reynolds-Haertle R.  Increased risk of death and cardiac arrest from encainide and flecainide in patients after non-Q-wave acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1991;;68:1551-1555.
5 +
Beck R, Cleary P, Andreson Jr M, et al.  A randomized controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med . 1992;;326:581-588.
6 +
Eddy DM.  Practice policies—guidelines for methods. JAMA . 1990;;263:1839-1841.
7 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
8 +
Sox HC, Woolf SH.  Evidence-based practice guidelines from the US Preventive Services Task Force. JAMA . 1993;;269:2678.
9 +
Mandel J, Bond J, Church T, et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med . 1993;;328:1365-1371.
10 +
Winawer S.  Colorectal cancer screening comes of age. N Engl J Med . 1993;;328: 1416-1417.
11 +
Selby J, Friedman G, Quesenberry C Jr, Weiss N.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med . 1992;; 326:653-657.
12 +
Davis G, Balart L, Schiff E, et al.  Treatment of chronic hepatitis C with recombinant interferon alfa: a multicenter randomized, controlled trial. N Engl J Med . 1989;;321:1501-1506.
13 +
Seeff LB, Buskell-Bales Z, Wright EC, et al.  Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med . 1992;;327:1906-1911.
14 +
Mettlin C, Lee F, Drago J, Murphy GP.  The American Cancer Society National Prostate Cancer Detection Program: findings on the detection of early prostate cancer in 2425 men. Cancer . 1991;;67:2949-2958.
15 +
Baker L.  Breast Cancer Detection Demonstration Project: five-year summary report. CA . 1982;;32:194-225.
16 +
Miller A, Baines C, To T, Wall C.  Canadian National Breast Screening Study, I: breast cancer detection and death rates among women ages 40 to 49 years. Can Med Assoc J . 1992;;147:1459-1476.
17 +
Office of Technology Assessment, US Congress. Report on Assessing Efficacy and Safety of Medical Technologies . Washington DC: Office of Technology Assessment; 1978;.
18 +
Fleming C, Wasson J, Albertsen P, Barry M, Wennberg J.  A decision analysis of alternative treatment strategies for clinically localized prostate cancer. JAMA . 1993;;269:2650-2658.
19 +
Eddy DM.  Uncertainty, outcomes, and the quality of medical care.  In: Proceedings: Cornerstones of Health Care in the Nineties: Forging a Framework of Excellence . September 16-18, 1990;; Hot Springs, Va. Sponsored by the Joint Commission on Accreditation of Healthcare Organizations and The Prudential Insurance Company of America.
20 +
Eddy DM.  Applying cost-effectiveness analysis: the inside story. JAMA . 1992;; 268:2575-2582.
21 +
Lundberg G.  American health care system management objectives: the aura of inevitability becomes incarnate. JAMA . 1993;;269:2554-2555.
22 +
Eddy DM.  Designing a practice policy: standards, guidelines, and options. JAMA . 1990;;263:3077, 3081, 3084.

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