All Prepaid Health Care Systems Are Not Equal-Reply

In reply  Wasserman commented that it is meaningless to analyze differences in outcomes without studying differences in other aspects of delivery systems. We agree that it is important to understand differences across systems of care in programs, management structures, and process of care, but this does not make outcome comparisons meaningless. A central feature of PP care is that it is provided in different settings and under different incentives than FFS care, ie, there are likely to be many programmatic and management differences. Yet, it is not clear whether entirely different systems of care are associated with different patient outcomes, and this is the subject of the analysis by Rogers et al (1993).¹However, because we found significant outcome differences among patients of psychiatrists, it now becomes worthwhile to focus on unraveling the mystery of the "black box" of the different systems of care—especially within psychiatry. Some of that can be