AS MANAGED health care systems take over American medicine, the free-spending era is reaching the beginning of its end. Current efforts directed at curtailing costs involve the use of primary care or non-physician gatekeepers to tell us what is right or wrong. Concurrently, the phenomenon of a financial incentive to provide "less care" is generating unease.
We (surgeons), who are being blamed for spending so much money and doing almost nothing about it, must not be surprised that the resource controls are being gradually taken away from us. Sure, we pay lip service to the idea of cost containment in lecture halls and board meetings; we also publish articles about cost-effectiveness, clinical pathways, and algorithms. But practically, in daily life, how many of us are actively preoccupied with the financial issues evolving around our surgical practice?
For how many of us is cost an issue in selecting diagnostic or therapeutic
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