Cost Containment: Medical System Rehabilitation or Reform*

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Cost containment is considered the premier goal for improvement of the medical care system. Before any other steps can be taken to improve availability, accessibility, or quality, or before introduction of any governmental programs for the removal of economic obstacles to obtaining medical care,—in other words, before any effort to make the medical care system more equitable—the rapid hyperinflation of medical care costs must be arrested. It is argued here that the defects of the system as currently operating are such that no cost control effort can be effective without radical change and reorganization of the system itself: methods of practice, methods of reimbursing providers, and methods of assuring accountability and supervision. And it is further argued, that if only cost control measures are instituted, not only will inflation not be stemmed, but it will be further aggravated and at the same time, the poor and minorities now suffering the consequences of an inadequate, ineffective, and unresponsive medical care system will be further deprived.

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