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• W1993757443 abstract "Editorials1 April 1984Cost Containment Confronts PhysiciansSTEPHEN J. MCPHEE, M.D., LOIS P. MYERS, M.P.P., BERNARD LO, M.D., GERALD CHARLES, M.D.STEPHEN J. MCPHEE, M.D.Search for more papers by this author, LOIS P. MYERS, M.P.P.Search for more papers by this author, BERNARD LO, M.D.Search for more papers by this author, GERALD CHARLES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-100-4-604 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPhysicians balance two potentially conflicting professional responsibilities: providing optimal care to patients and conserving society's resources. This conflict has been intensified by recent pressures to control the increasing costs of medical care. Physicians now face at least six dilemmas caused by cost-containment programs.First, the quality of care may suffer. Cost-containment programs assume that some medical care yields little or no benefit to the patient (1, 2). Although eliminating unnecessary services poses no ethical dilemma, reducing services of marginal, potential, or real benefit may threaten the quality of patient care (3). Physicians may have difficulty distinguishing between useful, marginal, or...References1. SCHROEDERMYERSMCPHEE SLS. The failure of physician education as a cost-containment strategy: report of a prospective controlled trial at a university hospital. JAMA. 1984; (In press). CrossrefGoogle Scholar2. ENTHOVEN A. Shattuck Lecture—cutting cost without cutting the quality of care. N Engl J Med. 1978;298:1229-38. CrossrefMedlineGoogle Scholar3. ORANDI A. I cut health costs and everybody suffered. Med Econ. 1977; 209-22. Google Scholar4. MCPHEEMYERSSCHROEDER SLS. The costs and risks of medical care: an annotated bibliography for clinicians and educators. West J Med. 1982;137:145-61. MedlineGoogle Scholar5. EDDY D. Clinical policies and the quality of clinical practice. N Engl J Med. 1982;307:343-7. CrossrefMedlineGoogle Scholar6. MYERSSCHROEDER LS. Physician use of services for the hospitalized patient: a review, with implications for cost containment. Milbank Mem Fund Q. 1981;59:481-507. CrossrefGoogle Scholar7. DIXONLASZLO RJ. Utilization of clinical chemistry services by medical house staff: an analysis. Arch Intern Med. 1974;134:1064-7. CrossrefMedlineGoogle Scholar8. GRAYMARION GR. Utilization of a hematology laboratory in a teaching hospital. Am J Clin Pathol. 1973;59:877-82. CrossrefMedlineGoogle Scholar9. MELIAAUCOINDUHLKUROKAWA ELLP. Competition in the health-care marketplace: a beginning in California. N Engl J Med. 1983;308:788-92. CrossrefMedlineGoogle Scholar10. SIDELMAHLERVEATCH VDR. Modification of residents' test-ordering behavior (Letter). N Engl J Med. 1981;304:918-9. CrossrefMedlineGoogle Scholar11. MARTINWOLFTHIBODEAUDZAUBRAUNWALD AMLVE. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980;303:1330-6. CrossrefMedlineGoogle Scholar12. SOXMARGULIESSOX HIC. Psychologically mediated effects of diagnostic tests. Ann Intern Med. 1981;95:680-5. LinkGoogle Scholar13. MAHLERVEATCHSIDEL DRV. Ethical issues in informed consent: research on medical cost containment. JAMA. 1982;247:481-5. CrossrefMedlineGoogle Scholar14. HERSHEY N. The defensive practice of medicine: myth or reality? Milbank Mem Fund Q. 1972;50:69-98. CrossrefMedlineGoogle Scholar15. RUBSAMEN D. A $500,000 jury verdict for negligence of a Medi-Cal consultant (Los Angeles County Superior Court no. NWC60672). Prof Liability News. 1982;13:1-3. Google Scholar16. DENSONMANNING TP. Current problems in medical practice: as viewed by California physicians. West J Med. 1982;136:369-72. MedlineGoogle Scholar17. EISENBERG J. An educational program to modify laboratory use by house staff. J Med Educ. 1977;52:578-81. MedlineGoogle Scholar18. Use of laboratory tests in a teaching hospital: long-term trends: reductions in use and relative cost. Ann Intern Med. 1979;90:243-8. LinkGoogle Scholar19. SCHROEDERSHOWSTACK SJ. Financial incentives to perform medical procedures and laboratory tests: illustrative models of office practice. Med Care. 1978;16:289-98. CrossrefMedlineGoogle Scholar20. ALMY T. The role of the primary physician in the health-care industry. N Engl J Med. 1981;304:225-8. CrossrefMedlineGoogle Scholar21. MOORE S. Cost containment through risk-sharing by primary-care physicians. N Engl J Med. 1979;300:1359-62. CrossrefMedlineGoogle Scholar22. LUFT H. How do health-maintenance organizations achieve their savings? Rhetoric and evidence. N Engl J Med. 1978;298:1336-43. CrossrefMedlineGoogle Scholar23. MOOREMARTINRICHARDSON SDW. Does the primary-care gatekeeper control the costs of health care? Lessons from the SAFECO experience. N Engl J Med. 1983;309:1400-4. CrossrefMedlineGoogle Scholar24. BEAUCHAMPCHILDRESS TJ. Principles of Biomedical Ethics. New York: Oxford University Press; 1979. Google Scholar25. HIATT H. Protecting the medical commons: who is responsible? N Engl J Med. 1975;293:235-41. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of California; San Francisco, California PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByVideo-Assisted Thoracoscopic Surgery for the Treatment of Congenital Cardiac Defects in the Pediatric PopulationPaediatric cardiac catheterization: innovationsWaiting for the doctor glut, or is the cavalry really coming?Impact of HMOs on emergency medical services: Another perspectivePrehospital emergency services and health maintenance organizationsInpatient Management Protocols to Reduce Health Care CostsHealth care cost containment and the duty to treatLegal and Ethical Implications of Health Care Reimbursement by Diagnosis Related Groups 1 April 1984Volume 100, Issue 4Page: 604-606KeywordsHealth care qualityPatients Issue Published: 1 April 1984 PDF DownloadLoading ..." @default.
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