Cost without Benefit

Cost containment has dominated recent debate on health policy. Most analysts agree that skyrocketing costs necessitate constraints on the amount of medical care delivered, but the best way to effect such rationing remains controversial.1 , 2 Clinical epidemiologists and economists have used cost-effectiveness analysis and other tools to dissect the necessary from the superfluous in medical practice.3 , 4 Government and industry have applied the blunter instruments of prospective payment systems and reductions in the number of people with health insurance and the comprehensiveness of coverage.5 6 7 While attention has been riveted on reducing the volume of services, the cost effectiveness of many nonclinical health . . .