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March 1986

A Culprit in Health Care Costs

Author Affiliations

Department of Internal Medicine Rush-Presbyterian—St Luke's Medical Center 1753 W Congress Pkwy Chicago, IL 60612

Arch Intern Med. 1986;146(3):460-461. doi:10.1001/archinte.1986.00360150058006

The present dilemma in medicine is how to continue to improve the quality of health care while maintaining a reasonable expenditure of resources. Although prospective payment legislation seems to be an admirable effort to decrease costs, unfortunate consequences can result under such provisions. For example, there could be health care rationing for the critically ill, a decline in medical education, decreased use of technology, increased litigation, and the development of specialty hospitals emphasizing favorable prospective payment groupings under diagnosis-related groups.1,2 Simultaneously, decreased availability of resources for research may occur, as well as a curb on testing of the risk or benefits of advancing technology. Such a system will inevitably lead to deterioration in the quality of health care.

Under the system of diagnosis-related groups, it has been estimated that as many as 20% of the nation's hospitals will be forced to close by 1990, yet the situation before

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