I run the second largest safety-net system in the United States. As is true of all safety-net systems in the United States, we have a finite budget; overwhelmingly, our patients are uninsured or publicly insured, so we cannot raise our rates to pay for emerging populations and treatments. Instead, I see our mission as trying to provide the best health care we can for the available funding (highest value).
Few would disagree with the mission of providing the highest-value health care possible. Unfortunately, the consensus dissipates when a particular practice is targeted for elimination because it provides little or no value. Such is the state of the prostate-specific antigen (PSA) test for prostate cancer screening. Although the US Preventive Services Task Force (USPSTF) recommended against its use for men 75 years or older in 20081 and in 2012 concluded that there is insufficient evidence to recommend routine screening for anyone,2 the test is still being ordered every day in every health care system including mine, reimbursed not only by private insurance but by public insurance (Medicare and Medicaid) and scarce county health dollars for the uninsured. Why is this? If the test is so unhelpful, why are we not able to devote the money to higher-value care?
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.