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Outlier Status of U.S. Health Care Costs
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
Dr. Keberlein argues that costs related to malpractice litigation are “the elephant in the room” of high and rising health care costs in the United States. Indeed, there are major differences between the malpractice systems of the United States and those of other nations. However, the problem can better be described as a “big dog in the room” rather than an elephant. Studies of the costs of malpractice litigation and “defensive medicine” practiced to protect against litigation estimate the costs to be 5% to 9% of health expenditures (1, 2)—a large sum, but not quite an elephant. Does the malpractice system need reform? Drastically. Could such reform solve the problem of high and rising costs? Probably not.
Dr. Hanks raises the point that most health care costs are personnel costs. In one sense, personnel costs are a good thing because these funds distribute jobs and income throughout society. If, however, as some research shows (3, 4), part of the problem of high and rising health care costs is related to excessive hospital days, emergency department visits, and overdiffusion of new technologies that do not improve health outcomes, then the personnel needed to provide these services is also excessive and costs could be reduced by eliminating these services. It is also not proven that modern information technology will improve productivity and reduce costs; overall, new technologies tend to increase expenditures (5).
Thomas Bodenheimer, MD
University of California at San Francisco
San Francisco, CA 94110
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
