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COMMENTS AND OPINIONS
HEALTH CARE REFORM
The 300-Year-Old Health Care Solution
H. Stephen Beyer, MD
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The health care reforms described by Diamond et al1 would create "evidence-based" codified medical practice standards. Their proposal and similar "pay-for-performance" programs will lead to "straight-jacket" medicine, in which to receive payment and avoid legal and economic sanctions, the goal will become to ensure that patients receive the correct codified treatment, not necessarily the one best suited. The danger is that patients may receive more inappropriate care, not less, as more who approximate falling within the guideline are included and fewer who fall within guidelines but may have caveats are not excluded—all for assured payment and to avoid penalties.
When treatment rules are codified, how easy or difficult will it be to challenge these rules and how much trouble will physicians have with government and insurance companies until guidelines are revised? Many of our beliefs and treatments today will become obsolete. Rather than codify practices and . . . [Full Text of this Article]
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