The catch-22's of cost containment.

While exploring the problem of escalation of health care expenditures in urology and analyzing various means to curtail this escalation, we noted a recurrent problem relating to the negative incentives inherent in presently used reimbursement mechanisms. Proposed solutions to a particular problem usually are accompanied by new economic difficulties arising from the solution. A series of Catch-22's are encountered in many different problems concerning economic health care delivery. We herein elucidate a number of these problems and propose a novel reimbursement system in which there are positive incentives provided to those urologists who make an honest effort at cost containment.