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Hayward commented, regarding performance-measure adherence for adults, "It sounds terrible . . . that 50% of recommended care is not received, but . . . mandating adherence to these recommendations is not necessarily in the best interest of patients or society. . . . At the heart of this problem is our wish to keep efforts at quality improvement and cost containment separate."2 Benefits from guidelines are not necessarily additive,3,4 since there are usually costs and sometimes unintended consequences.5
Although many believe that children, with their developmental needs and relative dependence, deserve unlimited health care resources, such resources do not appear to be available currently. Choices are necessary. For example, should we give priority to hospitalizing young febrile infants,1 or instead provide immunizations, health insurance, pharmaceuticals, or developmental or mental health services or both? Ignoring cost-effectiveness often results in illogical rationing of care.
I hope that this important study will catalyze discussion regarding our society's priorities for children, our most precious national resource.
Sharon B. Meropol, M.D., M.S.C.E.
University of Pennsylvania School of Medicine
Philadelphia, PA 19104
meropols{at}mail.med.upenn.edu
References
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