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November 1997

The Quality of Neurological Care, 1997

Author Affiliations

Neurological Institute 710 W 168th St, NI-14 New York, NY 10032-2603

Arch Neurol. 1997;54(11):1327-1328. doi:10.1001/archneur.1997.00550230008006

We can rail against managed care for many reasons, but the health maintenance organizations (HMOs) have come so fast and so powerfully that physicians just have to adapt. The central problem of health care "reform" is this: the goal is to reduce expenses, not to make anything better. Not patient care, and surely not teaching or research.

In the current "market-driven" economy of medicine, they tell us that neurologists are expensive and superfluous; the excess (perhaps half of us), they say, should be retrained for primary care or some other occupation. In the meantime, we are hassled in patient care—forced to argue with intermediaries on behalf of patients. Money is diverted from health care to pay for administrative costs, bloated executive salaries, and dividends for the shareholders of for-profit managed care companies. We spend huge amounts of time on defensive maneuvers—hospital mergers, development of hospital networks, formation of gigantic practice

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