HEALTHCARE DELIVERY
U.S. healthcare: the intertwined caduceus of physicians, coverage, quality, and cost
Arthur Garson, Jr, MD, MPH*,*
* University of Virginia School of Medicine, Charlottesville, Virginia, USA
Manuscript received January 14, 2003;
revised manuscript received May 22, 2003,
accepted June 2, 2003.
* Reprint requests and correspondence: Dr. Arthur Garson, Jr., Dean, School of Medicine, University of Virginia, Box 800793, Charlottesville, Virginia 22908, USA.
garson{at}virginia.edu
As cardiologists, we should increase our efforts to improve coverage, quality, and cost, both by caring for individual patients and by improving our systems. How? Coverage: by promoting a coordinated approach, beginning with state demonstrations of new safety net and individual and private insurance approaches. Quality: by adopting evidence-based practice and adapting practice guidelines for payment, beginning with non-payment for class III; by setting standards of practice below which we may not fall and paying for quality and service above this level; by involving patients as partners in their care and providing them with incentives. Cost: by challenging routine practices (why return in one year?); by beginning to address the widening gap between what is possible and what is affordable, taking part in broader discussions on what is worth the cost, supporting tort reform, and proposing alternatives; by improving our systems to reduce medical errors and addressing future physician shortages by working in teams with primary care physicians and nurses. Let's work with our patients to improve their health. Together we can make real progress.
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