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October 7, 1998

Prominence of Patients' Insurance Status in Clinical Crossroads—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(13):1137-1138. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-13-jbk1007

In Reply:We wish we could agree with Dr Amdur that "[i]nsurance status should never determine optimal medical management," but our experience tells us otherwise.

In creating Clinical Crossroads, we wanted to look through the patient's eyes, unlike the classic clinicopathologic conference. As physicians and patients, we know that many dimensions may bear on patient care—financial issues, ethical considerations, family issues, cultural issues, and access to care.1 Physicians cannot today ignore the relationship among patients, their health insurance, and the plan of care. A care plan may be state-of-the-art, but if insurance will not pay and the patient cannot pay, the patient may miss a benefit. Therefore, we intentionally placed this information front and center in patients' case histories to highlight the potential effect on care and outcomes.