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July 18, 2007

Changing the Organization of Health Care—Reply

Author Affiliations

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

JAMA. 2007;298(3):286-288. doi:10.1001/jama.298.3.287

In Reply: The letters by Dr Gandjour and by Drs Østbye and Michener each include important misconceptions about health care delivery. First, Gandjour asserts that improving quality raises costs, but then cites research on the use of quality programs to correct undercompliance with process guidelines, a conceptually different issue from improving health and risk-adjusted outcomes. Improving health outcomes usually reduces costs because health costs less than illness. Efficiency is enhanced by quality improvements that yield effective prevention, more accurate diagnoses, fewer treatment errors, fewer complications, faster recoveries, less invasive treatment, less disease progression, more effective treatment, and less disability. The good being created is health, not treatment, and the measure of success is risk-adjusted health outcomes. When physicians do not measure results, it is difficult to distinguish between more care and better care.

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