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Cost Containment Confronts Physicians

STEPHEN J. MCPHEE, M.D.; LOIS P. MYERS, M.P.P.; BERNARD LO, M.D.; and GERALD CHARLES, M.D.
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University of California; San Francisco, California


Ann Intern Med. 1984;100(4):604-606. doi:10.7326/0003-4819-100-4-604
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Physicians balance two potentially conflicting professional responsibilities: providing optimal care to patients and conserving society's resources. This conflict has been intensified by recent pressures to control the increasing costs of medical care. Physicians now face at least six dilemmas caused by cost-containment programs.

First, the quality of care may suffer. Cost-containment programs assume that some medical care yields little or no benefit to the patient (1, 2). Although eliminating unnecessary services poses no ethical dilemma, reducing services of marginal, potential, or real benefit may threaten the quality of patient care (3). Physicians may have difficulty distinguishing between useful, marginal, or

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cost control

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