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May 1990

Socioeconomic Changes Impact Medical Practice

Author Affiliations

Chicago, Ill

Arch Ophthalmol. 1990;108(5):633-634. doi:10.1001/archopht.1990.01070070019002

To the Editor.  —In his recent Special Article, Sacks1 raises relevant and sometimes overlooked factors that have contributed to the current socioeconomic quandaries that confront physicians. These merit emphasis and dissemination.In considering the genesis of health care cost inflation, Sacks underscores that insurance greatly shields patients from the true burden of the cost of the care he or she purchases. Patients are rendered even less sensitive to costs where employers provide health care coverage as a nontaxable benefit. As he points out, increasing the insurance deductible or strengthening cost-sharing provisions would make the consumer a much more astute purchaser of services. This requires sacrifice and a political will that is not currently evident in the United States.Sacks also notes that bringing the salaries of hospital nonprofessionals up to parity has greatly accelerated cost inflation. This is a relatively obscure but important point. In the 1950s and

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