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The Risks of Substitution of Therapeutic Modalities by Cheaper and Sometimes Less Effective Agents

Arch Intern Med. 1990;150(3):688-689. doi:10.1001/archinte.1990.00390150154038.
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To the Editor.—A growing risk affecting patient care has developed in the past few years that physicians should be aware of. The issue in question is the attempt that is made by many major and minor health care facilities, including many private and public hospitals, to cut costs by abandoning wellestablished drugs, and switching to other agents that are less expensive, but, in many cases, much less effective. This change is usually done by the hospital pharmacy, or the pharmaceutical committees of the institution, where their major goal is to save money. Ironically, these savings are not passed on to the patient and only increase the profitability of the hospital or health care provider.

The origin of this trend arose from (Continued on p 689.) (Continued from p 688.) the new federal government regulations known as "DRG" (diagnosis related groups), which were instituted about 4 years ago.1 These


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