To the Editor.—
In the Feb 13 issue of The Journal, Melvin Shapiro, MD (1981;245:577), sets forth guidelines for restricting the performance of gastrointestinal endoscopy. Such concern over who should do endoscopy is complicated by the fact that it remains unclear who should get endoscopy. A recent article in The New England Journal of Medicine1 documents well the financial incentives of technical procedures that could be confounding the issue.In the current political situation it is quite likely there will be severe cutbacks in federally funded third-party payment for medically indigent patients. In addition, they will be barred from hospital settings as more and more public hospitals are responding to the economic crunch by instituting preadmission financial screening in all but the most extreme emergencies.If gastrointestinal endoscopy is truly an important health care modality that should be performed only by highly trained specialists, then it can be seen as
Cassel C. Performance of Gastrointestinal Endoscopy. JAMA. 1981;246(15):1658–1659. doi:10.1001/jama.1981.03320150018011
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