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(Circulation. 1996;94:869-871.)
© 1996 American Heart Association, Inc.

Articles

Importance of Cost and Quality of Life in Decisions About Routine Angiography After Acute Myocardial Infarction

The Role of Cost-effectiveness Models

Eric L. Eisenstein, DBA; Daniel B. Mark, MD, MPH; Robert M. Califf, MD

the Duke Clinical Research Institute, Duke University, Durham, NC.

Correspondence to Robert M. Califf, MD, Box 31123, DUMC, Durham, NC 27710.

Key Words: Editorials • infarction • cost-benefit analysis • angiography

	Introduction

 
In 1992, health care was the fastest-growing sector of the US economy, accounting for 14% of the gross national product. Amid concern about whether such rapid growth could realistically be sustained, the editor of the Journal of the American Medical Association predicted that the US healthcare system would experience an apocalyptic "meltdown" by 1996 if the situation persisted.¹ Four years later, the US healthcare system has not experienced "meltdown." However, the manner in which healthcare services are provided, financed, and evaluated has changed dramatically. Healthcare insurers and policy makers have justified these changes by asserting that Americans receive much unnecessary health care and that even the necessary care is overpriced. In contrast to the US situation, Canada and the Western European countries spend less per capita on health care but have apparently similar levels of overall health as measured by key indicators.

Beginning with the use of diagnosis-related groups in the early 1980s, hospitals and physicians witnessed an accelerating shift of financial responsibility from insurers and other health services purchasers to healthcare providers. By 1992, many providers had found that reimbursements from Medicare and Medicaid were not adequate to cover their expenses for these services.^{2 3} Four years later, capitation and other forms of managed care have so limited reimbursements from private insurers that many providers are unable to cover their expenses for these patients as well. In this increasingly competitive healthcare environment, providers, purchasers, and policy makers are finding that they can no longer finance healthcare services at their pre-1992 . . . [Full Text of this Article]