To the Editor.
—In the September 14, 1994, issue of JAMA, Dr Eddy1 uses three examples of increasing efficiency of utilizing limited health care resources. However, his first two examples, restricting mammography to more appropriate ages and changing the indications for cholesterol-reducing drug therapy, differ significantly from his third example, the use of high (HOCA) or low (LOCA) osmolar contrast agents balanced against the use of cervical cancer screening. In the first two examples, Eddy cites published scientific data to support a constructive and efficient reduction of overutilization of a single resource (mammography in the first case and cholesterol-reducing drugs in the second case), resulting in improvement in the quality of care, each for one specific illness.In his third example, however, the only resource common to both interventions is money; two unrelated illnesses are being balanced. He advocates administering HOCAs to all patients, even to those demonstrated to
Fisher BL. Rationing Resources While Improving Quality. JAMA. 1995;273(13):995. doi:10.1001/jama.1995.03520370035018