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October 11, 1995

Controlling Costs: The Case of Kaiser

Author Affiliations

Kaiser Permanente Pasadena, Calif

JAMA. 1995;274(14):1135. doi:10.1001/jama.1995.03530140047029

To the Editor.  —The article by Drs Grumbach and Bodenheimer on mechanisms for controlling costs1 raises some interesting theoretical ideas about how organizational factors can be used to influence price, cost, and use. Unfortunately, the use of the Kaiser Permanente Medical Care Program as an example of supply limits to control physician use of magnetic resonance imaging (MRI) examinations is incorrect. It also maligns our program, our physicians, and the processes we use to provide high quality care to our members.Our physicians have worked hard to develop clinical practice guidelines for the use of MRI scans and many other tests and treatments. These guidelines are based on scientific evidence when empirical data are available, and on a formal consensus among our physician experts when empirical data are not sufficient to create evidence-based guidelines.We make MRI machine purchasing decisions based on careful forecasts of need. These forecasts are

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