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REPLY
Patients' Expectations and Demand Management
Richard L. Kravitz, MD, MSPH, and
Edward J. Callahan, PhD
1 May 1997 | Volume 126 Issue 9 | Page 744
IN RESPONSE:
We appreciate Drs. Vickery and Lynch's comments about demand management. They assert that the purpose of demand management is to encourage the appropriate use of health care services by helping patients and physicians to make wise medical decisions. Defined in this way, the concept may well be unassailable. Our disagreement is not with demand management as the authors idealize it but rather with how it has been promoted and implemented in actual practice. There is no doubt that "understanding the perceptions, attitudes, and beliefs that determine patient behavior is essential for improving health care." The difficulty comes in developing systems that simultaneously minimize costs, maximize health, and respect patients' preferences. In case physicians did not already know it, our work highlights just how difficult this task can be.
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University of California, Davis, Sacramento, CA 95817
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