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April 22, 1992

Quality of Care-Reply

Author Affiliations

Value Health Sciences, Inc Santa Monica, Calif

JAMA. 1992;267(16):2188. doi:10.1001/jama.1992.03480160044030

In Reply.  —Dr Friedell identifies several factors related to the availability of radiation therapy facilities and health insurance coverage that might influence treatment decisions for women with breast cancer. I agree and stated in my Editorial that hospitals should not be blamed for features of the health care system beyond their control that hinder the provision of good quality care. Good measures of quality can assess the price in lowered quality that we as a society pay by failing to provide equal access to good-quality care.I agree with Dr John that women with early-stage breast cancer should receive complete and objective information about alternative treatments. John believes that providing such data will increase the proportion of women opting for BCS, certainly a reasonable hypothesis. I made a different point in my Editorial: we cannot conclude from the fact that 34% of women with early-stage disease undergo BCS that the