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March 14, 1986

Cost Containment and the Physician

JAMA. 1986;255(10):1287. doi:10.1001/jama.1986.03370100081007

To the Editor.—  Dr Angell1 provides thought-provoking, practical analysis and advice in her article, "Cost Containment and the Physician." She suggests that the profession support the revision of fee schedules so that they no longer reward the use of tests and procedures as the single most important reform to be made in the present system. This general statement could have been strengthened by examples, and I offer an important one.Perhaps half of all radiological examinations in the United States are performed in the primary physician's office. In this self-referral situation it is clearly impossible for the physician to be unbiased in deciding what needs to be done for the patient. A substantial reduction in the fee schedule for examinations performed in this setting would undoubtedly help to resolve this problem.