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To the Editor:—
It is unfortunate that Dr. Roth's otherwise comprehensive report (197:347, 1966) did not discuss a serious inequity in the provisions of Medicare which extends outpatient diagnostic services to beneficiaries under parts A and B, subject to a $20 deductible in hospital outpatient departments while charging a $50 deductible for the same services in the offices of private radiologists and pathologists. This is further aggravated by Blue Shield, Medicare-65 plans (as in New Jersey and Pennsylvania) which pay both the deductible and the 20% coinsurance only to the hospital outpatient departments and not to the private specialists. The bias of the law extends also to those covered under part A only, for they receive supplemental payments for x-ray and pathology examinations only in hospital outpatient departments and not in physicians' offices.Thus by economic pressure resulting from legislative decree, the government is directing patient referral in the
Ellenbogen LS. Medicare Problems. JAMA. 1966;198(1):90. doi:10.1001/jama.1966.03110140140046