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November 1991

Changing Physician Behavior: Increasing Challenges for the 1990s

Author Affiliations

Division of General Medicine (Section on Health Services and Policy Research) Brigham and Women's Hospital Harvard Medical School 25 Shattuck St Parcel B, First Floor Boston, MA 02115

Arch Intern Med. 1991;151(11):2147-2149. doi:10.1001/archinte.1991.00400110011003

Although interest in cost containment is long-standing, it has recently resurged on a national level. This resurgence is partly the result of federal budgetary pressure caused by ever-increasing health care expenditures. However, the resurgence also reflects the combined effects of research from groups of investigators based at Dartmouth College (Hanover, NH) and the Rand Corporation (Santa Monica, Calif). For many years now, Wennberg et al1-3 and others4 have documented large variations in the use of various health care services in different geographic areas without apparent differences in medical need. More recently, Chassin et al5 and Winslow and colleagues6 showed that in up to a third of instances high-cost procedures may be ordered inappropriately. Together these two findings highlight the attractive possibility that more appropriate use of health care services could simultaneously improve quality of care and save money.

The major restructuring of Medicare physician payment policy

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