What is “appropriate” care?

Although there is nothing really new here, pre-eminent health economist Victor Fuchs has once again described the US Health system dilemma with eloquence in the NEJM’s Health Policy and Reform section.

Fuchs describes the dilemma between providing the best care possible for each patient, whilst maintaining the cost-effective management of limited clinical resources. It is a problem that I think is embedded in the psyche of doctors even while in training: “if the patient is not paying for it, and I am not paying for it, then why not give them the most expensive treatment available? Most expensive is best, right?”

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