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Previous Volume 350:1469 April 1, 2004 Number 14 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: Although Schneider et al. (Jan. 8 issue)¹ state that the results of their analysis of the rates of use of high-cost procedures is "counterintuitive," I suggest that their data are an expected result of physician-reimbursement structures. Physicians largely determine utilization rates for "high-discretion" procedures, such as cardiac catheterization. In settings where it is profitable for the physician, if not the health plan, to increase utilization, that is exactly what will occur. Until the system is changed, patients will undergo catheterization for both diseases and dollars.

Saul Schaefer, M.D.
University of California, Davis
Davis, CA 95616
sschaefer@ucdavis.edu

1. Schneider EC, Zaslavsky AM, Epstein AM. Use of high-cost operative procedures in for-profit and not-for-profit health plans. N Engl J Med 2004;350:143-150. [Free Full Text]

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