In Reply Dr Rosner raises interesting points that are sure to become even bigger issues, as we are now in an era of increasing patient out-of-pocket costs from copays and deductibles. In a strictly third-party system, patients rarely saw or suffered direct financial consequences from bills for “superfluous and expensive” tests that they did not request or, as in my brother’s case, specifically declined.
However, as more plans on the exchanges and consumer-directed health plans include substantial out-of-pocket costs, patients are likely to push back harder on unnecessary costs, no matter who orders them.
Redberg RF. Response to “Mandatory Anesthesia”—Reply. JAMA Intern Med. 2014;174(6):1011. doi:10.1001/jamainternmed.2014.1412