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July 18, 2007

Changing the Organization of Health Care

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(3):286-288. doi:10.1001/jama.298.3.286-a

To the Editor: In their Special Communication, Drs Porter and Teisberg1 make a number of reasonable suggestions for how to improve the quality of health care. However, I consider their fundamental assumption (better quality of care reduces health care costs) questionable. Many health care interventions increase health care costs.2 This means that improving the quality of care by reducing an underuse of health care interventions will in general increase rather than decrease costs. Given that US adults receive only 55% of recommended care3 and that each unit reduction of a quality deficit results in an overproportional increase of costs,4 vast resources may be needed to achieve high quality of care.

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