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November 9, 1994, Vol 272, No. 18 >
ARTICLE | November 9, 1994

Painful vs Painless Cost Control FREE

Kevin Grumbach, MD; Thomas Bodenheimer, MD, MPH
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West).

Corresponding author: Kevin Grumbach, Box 1364, University of California—San Francisco, San Francisco, CA 94143-1364.


JAMA. 1994;272(18):1458-1464. doi:10.1001/jama.1994.03520180082043
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References

Dr Joshua Worthy is chief of neurology at a large staff-model health maintenance organization (HMO) and serves as the physician representative to the HMO's executive committee. Other members of the executive committee include the hospital and HMO plan chief executive officers (CEOs), representatives of nursing and other staff, and members of the HMO's consumer board of directors. A national health plan has just been enacted that imposes mandatory cost controls. The HMO's budget for the coming year will be frozen at virtually the current-year level, allowing adjustment only for the rate of overall inflation of the US consumer price index—an increase of 1% to 2%. In past years, the annual growth in the HMO's budget has averaged 12% to 15%. The health plan CEO begins the committee meeting by groaning, "These cuts are draconian! To meet these new budget limits we'll have to cut staff and ration lifesaving procedures. Patients

REFERENCES

1 +
Burner ST, Waldo DR, McKusick DR.  National health expenditures projections through 2030. Health Care Financing Rev . 1992;;14:1-29.
2 +
Evans RG. Strained Mercy: The Economics of Canadian Health Care . Toronto, Ontario: Butterworth; 1984;.
3 +
Aaron H, Schwartz W. The Painful Prescription: Rationing Hospital Care . Washington, DC: The Brookings Institution; 1984;.
4 +
Aaron H, Schwartz WB.  Rationing health care: the choice before us. Science . 1990;;247:418-422.
5 +
Fuchs VR.  No pain, no gain: perspectives on cost containment. JAMA . 1993;;269: 631-633.
6 +
Donabedian A.  Quality and cost: choices and responsibilities. Inquiry . 1988;;25:90-99.
7 +
Stafford RS.  Alternative strategies for controlling rising cesarean section rates. JAMA . 1990;;263:683-687.
8 +
Eddy DM.  The individual vs society: is there a conflict? JAMA . 1991;;265:1446-1450.
9 +
Greenlick MR.  Educating physicians for population-based clinical practice. JAMA . 1992;;267:1645-1648.
10 +
Susser M.  Health as a human right: an epidemiologist's perspective on the public health. Am J Public Health . 1993;;83:418-426.
11 +
Lomas J, Fooks C, Rice T, Labelle RJ.  Paying physicians in Canada: minding our Ps and Qs. Health Aff (Millwood) . 1989;;8( (1) ):80-102.
12 +
Reinhardt UE.  Resource allocation in health care: the allocation of lifestyles to providers. Milbank Q . 1987;;65:153-176.
13 +
Fuchs VR.  The health sector's share of the gross national product. Science . 1990;;247:534-538.
14 +
Eisenberg JM. Doctors' Decisions and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press; 1986;.
15 +
Brook RH, Lohr KN.  Will we need to ration effective health care? Issues Sci Technol . 1986;;3:68-77.
16 +
Leape LL.  Unnecessary surgery. Annu Rev Public Health . 1992;;13:363-383.
17 +
Chassin MR, Kosecoff J, Park RE, et al.  Does inappropriate use explain geographic variations in the use of health care services? a study of three procedures. JAMA . 1987;;258:2533-2537.
18 +
Greenspan AM, Kay HR, Berger BC, et al.  Incidence of unwarranted implantation of permanent cardiac pacemakers in a large medical population. N Engl J Med . 1988;;318:158-163.
19 +
Wennberg JE.  The paradox of appropriate care. JAMA . 1987;;258:2568-2569.
20 +
Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H.  Effectiveness in health care: an initiative to evaluate and improve medical practice. N Engl J Med . 1988;;319:1197-1202.
21 +
Grimes DA.  Technology follies: the uncritical acceptance of medical innovation. JAMA . 1993;;269:3030-3033.
22 +
Woolhandler S, Himmelstein D.  The deteriorating administrative efficiency of the US health care system. N Engl J Med . 1991;;324:1253-1258.
23 +
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief. JAMA . 1987;;257:220-224.
24 +
Legorreta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL.  Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA . 1993;;270:1429-1432.
25 +
White CC, Koplan JP, Orenstein WA.  Benefits, risks, and costs of immunization for measles, mumps, and rubella. Am J Public Health . 1985;;75:739-744.
26 +
Institute of Medicine. Prenatal Care: Reaching Mothers, Reaching Infants: Summary and Recommendations . Washington, DC: National Academy Press; 1988;.
27 +
Stason WB.  Economics in hypertension management: cost and quality trade-offs. J Hypertension . 1987;;5( (suppl) ):S55-S59.
28 +
Eisenberg JM.  Clinical economics. JAMA . 1989;;262:2879-2886.
29 +
Cummings SR, Rubin SM, Oster G.  The cost-effectiveness of counseling smokers to quit. JAMA . 1989;;261:75-79.
30 +
Menzel PT.  Oregon's denial: disabilities and the quality of life. Hastings Cent Rep . 1992;;22:21.
31 +
Eddy DM.  Applying cost-effectiveness analysis: the inside story. JAMA . 1992;; 268:2575-2582.
32 +
Eddy DM.  Broadening the responsibilities of practitioners: the team approach. JAMA . 1993;;269:1849-1855.
33 +
Hiatt HH.  Protecting the medical commons: who is responsible? N Engl J Med . 1975;;293:235-241.
34 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton & Lange; 1995;.
35 +
Ginzberg E.  Cost-containment: imaginary and real. N Engl J Med . 1983;;308: 1220-1224.
36 +
Platt R.  Cost-containment: another view. N Engl J Med . 1983;;309:726-730.
37 +
Schieber GJ, Poullier J, Greenwald LM.  Health spending, delivery, and outcomes in OECD countries. Health Aff (Millwood) . 1993;;12( (2) ):120-129.

Figures

Tables

Interactive Graphics

Video

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 +
Burner ST, Waldo DR, McKusick DR.  National health expenditures projections through 2030. Health Care Financing Rev . 1992;;14:1-29.
2 +
Evans RG. Strained Mercy: The Economics of Canadian Health Care . Toronto, Ontario: Butterworth; 1984;.
3 +
Aaron H, Schwartz W. The Painful Prescription: Rationing Hospital Care . Washington, DC: The Brookings Institution; 1984;.
4 +
Aaron H, Schwartz WB.  Rationing health care: the choice before us. Science . 1990;;247:418-422.
5 +
Fuchs VR.  No pain, no gain: perspectives on cost containment. JAMA . 1993;;269: 631-633.
6 +
Donabedian A.  Quality and cost: choices and responsibilities. Inquiry . 1988;;25:90-99.
7 +
Stafford RS.  Alternative strategies for controlling rising cesarean section rates. JAMA . 1990;;263:683-687.
8 +
Eddy DM.  The individual vs society: is there a conflict? JAMA . 1991;;265:1446-1450.
9 +
Greenlick MR.  Educating physicians for population-based clinical practice. JAMA . 1992;;267:1645-1648.
10 +
Susser M.  Health as a human right: an epidemiologist's perspective on the public health. Am J Public Health . 1993;;83:418-426.
11 +
Lomas J, Fooks C, Rice T, Labelle RJ.  Paying physicians in Canada: minding our Ps and Qs. Health Aff (Millwood) . 1989;;8( (1) ):80-102.
12 +
Reinhardt UE.  Resource allocation in health care: the allocation of lifestyles to providers. Milbank Q . 1987;;65:153-176.
13 +
Fuchs VR.  The health sector's share of the gross national product. Science . 1990;;247:534-538.
14 +
Eisenberg JM. Doctors' Decisions and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press; 1986;.
15 +
Brook RH, Lohr KN.  Will we need to ration effective health care? Issues Sci Technol . 1986;;3:68-77.
16 +
Leape LL.  Unnecessary surgery. Annu Rev Public Health . 1992;;13:363-383.
17 +
Chassin MR, Kosecoff J, Park RE, et al.  Does inappropriate use explain geographic variations in the use of health care services? a study of three procedures. JAMA . 1987;;258:2533-2537.
18 +
Greenspan AM, Kay HR, Berger BC, et al.  Incidence of unwarranted implantation of permanent cardiac pacemakers in a large medical population. N Engl J Med . 1988;;318:158-163.
19 +
Wennberg JE.  The paradox of appropriate care. JAMA . 1987;;258:2568-2569.
20 +
Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H.  Effectiveness in health care: an initiative to evaluate and improve medical practice. N Engl J Med . 1988;;319:1197-1202.
21 +
Grimes DA.  Technology follies: the uncritical acceptance of medical innovation. JAMA . 1993;;269:3030-3033.
22 +
Woolhandler S, Himmelstein D.  The deteriorating administrative efficiency of the US health care system. N Engl J Med . 1991;;324:1253-1258.
23 +
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief. JAMA . 1987;;257:220-224.
24 +
Legorreta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL.  Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA . 1993;;270:1429-1432.
25 +
White CC, Koplan JP, Orenstein WA.  Benefits, risks, and costs of immunization for measles, mumps, and rubella. Am J Public Health . 1985;;75:739-744.
26 +
Institute of Medicine. Prenatal Care: Reaching Mothers, Reaching Infants: Summary and Recommendations . Washington, DC: National Academy Press; 1988;.
27 +
Stason WB.  Economics in hypertension management: cost and quality trade-offs. J Hypertension . 1987;;5( (suppl) ):S55-S59.
28 +
Eisenberg JM.  Clinical economics. JAMA . 1989;;262:2879-2886.
29 +
Cummings SR, Rubin SM, Oster G.  The cost-effectiveness of counseling smokers to quit. JAMA . 1989;;261:75-79.
30 +
Menzel PT.  Oregon's denial: disabilities and the quality of life. Hastings Cent Rep . 1992;;22:21.
31 +
Eddy DM.  Applying cost-effectiveness analysis: the inside story. JAMA . 1992;; 268:2575-2582.
32 +
Eddy DM.  Broadening the responsibilities of practitioners: the team approach. JAMA . 1993;;269:1849-1855.
33 +
Hiatt HH.  Protecting the medical commons: who is responsible? N Engl J Med . 1975;;293:235-241.
34 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton & Lange; 1995;.
35 +
Ginzberg E.  Cost-containment: imaginary and real. N Engl J Med . 1983;;308: 1220-1224.
36 +
Platt R.  Cost-containment: another view. N Engl J Med . 1983;;309:726-730.
37 +
Schieber GJ, Poullier J, Greenwald LM.  Health spending, delivery, and outcomes in OECD countries. Health Aff (Millwood) . 1993;;12( (2) ):120-129.

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