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January 25, 1995

Health System Reform: Will Controlling Cost Require Rationing Services?

Author Affiliations

Toledo, Ohio

JAMA. 1995;273(4):285. doi:10.1001/jama.1995.03520280028025

To the Editor.  —Dr Eddy1 blames "30% of the unacceptable increase [in medical prices to] medical price inflation in excess of general price inflation." Many physicians, like me, have a hard time believing this. I have received no increase in payment for a unit of work from the Blues in my 6½ years in practice here, have seen cuts in reimbursements and copayments in Medicare payments, and have seen minimal, if any, increase in health maintenance organization (HMO) and preferred provider organization (PPO) payments. Only charges to our private-pay patients have increased, and if the patient doesn't have insurance, frequently I don't get paid. My charge to private-pay patients has increased by a compound annual rate of 4.5% per year, but many of my insured patients have switched or have been switched to lower-paying HMOs or PPOs. The net result of all this discounting is that my average payment

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