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Increasing Challenges for the 1990s

Arnold M. Epstein, MD, MA

Arch Intern Med. 1991;151(11):2147-2149.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Although interest in cost containment is long-standing, it has recently resurged on a national level. This resurgence is partly the result of federal budgetary pressure caused by ever-increasing health care expenditures. However, the resurgence also reflects the combined effects of research from groups of investigators based at Dartmouth College (Hanover, NH) and the Rand Corporation (Santa Monica, Calif). For many years now, Wennberg et al^1-3 and others⁴ have documented large variations in the use of various health care services in different geographic areas without apparent differences in medical need. More recently, Chassin et al⁵ and Winslow and colleagues⁶ showed that in up to a third of instances high-cost procedures may be ordered inappropriately. Together these two findings highlight the attractive possibility that more appropriate use of health care services could simultaneously improve quality of care and save money.

The major restructuring of Medicare physician payment policy . . . [Full Text PDF of this Article]

Author Affiliations
Division of General Medicine (Section on Health Services and Policy Research) Brigham and Women's Hospital Harvard Medical School 25 Shattuck St Parcel B, First Floor Boston, MA 02115

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