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January 11, 1980

Medical Costs

Author Affiliations

C. S. Wilson Memorial Hospital Johnson City, NY

JAMA. 1980;243(2):118. doi:10.1001/jama.1980.03300280016008

To the Editor.—  The observations made by Dresnick et al (241:1606, 1979) are embarrassing but not surprising. While I agree with the authors' hypothesis that a more accurate knowledge of medical costs should reduce the number of diagnostic and therapeutic interventions, I suggest that their study has possibly focused on the wrong data.That a hospital bills a patient (or, more likely, a third-party payor) $25 for an ECG does not mean that it costs the hospital $25 to perform this service. The technician who records the tracing must be paid whether he does one or 20 in a given period; the machine itself must be purchased, serviced, and ultimately replaced. The actual cost to the "health-care system" of recording patients' ECGs is in fact not much influenced by the number of such tests ordered—and this is true for most of the authors' questionnaire items.As Dresnick and associates point