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—We agree entirely with the points made by Dr Friedell. If reimbursement doesn't cover costs, one has a difficult time maintaining a quality product. We believe the problem is with the system, not the hospitals.We disagree with Drs Katterhagan and Howe. There were 224 medical-surgical hospitals in Illinois in 1988. Our study of 99 hospitals accounted for 85% of all breast cancer patients diagnosed in the state that year. Three large urban hospitals with cancer programs that declined to participate in the study accounted for another 10%. This left roughly 5% of all breast cancer patients (less than 300 cases) spread among the 120 or so hospitals without cancer programs (these numbers are in our "Methods" section). We don't think it's fair or worthwhile to examine an institution based on its treatment of, on average, fewer than three patients.The results they present in their letter are
Hand R. Quality of Care-Reply. JAMA. 1992;267(16):2188. doi:10.1001/jama.1992.03480160044031