To the Editor.
—Braveman et al1 very elegantly provide documentation that babies who are not covered by "adequate" health insurance have fewer resources applied to their medical problems. But is their inference that these infants are getting suboptimal care valid?They state that, "It seems reasonable that medical procedures not necessarily associated with lowering the risk of adverse health outcomes, and even medically indicated elective procedures, would be kept to a minimum for newborns, especially sick ones." There is a different way to look at the same data—that of the behaviorist.Neonatologists, like all of us, are rewarded for their behaviors, which include procedures that they perform. If their compensation is enhanced (that is they get paid) for a particular behavior procedure in a particular group of patients, they are more likely to repeat that behavior. If, on the other hand, no reward results from a particular behavior, it
Johnson DF. Hospital Resource Allocation and Insurance Coverage. JAMA. 1992;267(13):1778. doi:10.1001/jama.1992.03480130090023