MEDICINE IS an uncertain art. With current literature ranging from Wennberg's1 pioneering work on large variations in rates of procedures in different geographic areas to the work of Chassin and associates2 on inappropriate surgical procedures, it is accepted that care and utilization patterns vary tremendously. While millions of Americans lack access to adequate care, others receive unnecessary or inappropriate care. The explosion of for-profit, prepaid health care (managed care) systems has exacerbated the situation and generated concerns about the quality of care provided. Indeed, there are more questions and issues about managed care and how delivery systems provide care than there are answers.3
Lee P. Assessing Quality and Utilization Patterns in Health Care Delivery Systems. Arch Ophthalmol. 1998;116(2):234–235. doi:10.1001/archopht.116.2.234
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