Angell M
JAMA. 1985 Sep 6;254(9):1203-7.
The rapid rise in health care costs is receiving a good deal of attention these days. Proposed responses include the deliberate rationing of expensive medical technologies, such as organ transplantation, and a redirection of our efforts toward preventive care. Although preventive care may improve our health, it cannot be assumed to reduce medical costs, since a later death may be as expensive as an earlier one. I suggest that a major and rapidly growing component of medical costs stems from the widespread application of tests and procedures when they are of no demonstrated benefit and may even be harmful. Identifying and curtailing such unnecessary medical care, rather than rationing beneficial technologies, should be the thrust of cost-containment efforts. Fee schedules should be revised so that they neither encourage nor discourage the use of tests and procedures; we should undertake systematic studies to assess technologies and practices; and we should make every effort to discourage the practice of defensive medicine. The involvement of physicians in rationing is not only premature; it is also inconsistent with our role as advocates for the health of our patients.
如今，医疗保健费用的迅速上涨备受关注。提出的应对措施包括对昂贵医疗技术（如器官移植）进行有意的配给，以及将我们的努力重新导向预防性护理。虽然预防性护理可能会改善我们的健康状况，但不能假定它会降低医疗成本，因为较晚死亡可能与较早死亡一样昂贵。我认为，医疗成本中一个主要且迅速增长的部分源于在没有证明其益处甚至可能有害时广泛应用检测和程序。确定并减少此类不必要的医疗护理，而不是对有益技术进行配给，应该是成本控制努力的重点。费用表应该修订，使其既不鼓励也不阻碍检测和程序的使用；我们应该进行系统研究以评估技术和实践；我们应该尽一切努力劝阻防御性医疗行为。医生参与配给不仅为时过早；这也与我们作为患者健康倡导者的角色不符。
