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Setting Limits in Clinical Medicine

Donald J. Murphy, MD; Gail J. Povar, MD, MPH; L. Gregory Pawlson, MD, MPH
Arch Intern Med. 1994;154(5):505-512. doi:10.1001/archinte.1994.00420050045005.
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THE FACTS are too FACTS miliar. More than 37 million US citizens have no health care insurance, while health care costs have reached 14% of our gross national product. These costs continue to increase at a rate more than twice as fast as inflation. At the current rate of growth, health care costs would exceed 30% of our gross national product by 20301 and, theoretically, would reach 100% by 2090.2 Providing care to the underinsured will further increase costs.

While reducing administrative costs, reducing physician and hospital reimbursement, eliminating interventions of no benefit, and increasing utilization review will produce one-time cost savings, they are unlikely to alter the overall rate of change.3 A simple fact of mathematics is that marginal benefit becomes infinitely small (and thus infinitely costly) before it turns negative. Those who argue we should provide all beneficial care must defend spending a million dollars


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