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January 12, 2011

Is Choice of Physician and Hospital an Essential Benefit?

Author Affiliations

Author Affiliation: RAND Corporation, Santa Monica, California.

JAMA. 2011;305(2):195-196. doi:10.1001/jama.2010.1987

In the 1970s, health care was simpler. The fields of transplant surgery, clinical pharmacology, and clinical oncology, among others, were just emerging. The proportion of the gross national product spent on health care was in the low single digits. There were no preferred provider organizations, no publicly available data indicating which surgeon was better than another, no evidence-based medicine movement, or any other kind of information designed to help individuals make treatment choices. In the 1970s, it was reasonable for health insurance to cover the entire gamut of health care, from what currently would be called complementary and alternative medicine to traditional medicine. For those with health insurance, no matter what kind of service a physician and patient agreed to, the service was covered without either evidence that it was effective or prior authorization.