I think there are also concerns with the formularies, about who is making the decisions and who has the liability. If the provider is making the decision, that is one thing. This is harder to do, because it is not necessary to put a diagnosis on a prescription medication, so it is not as easy to track in terms of the cost benefit for a particular diagnosis. We have been tracking, for example, the costs of paying pharmacists to help monitor asthma medications, including inhalers, for our asthma patients. We are seeing fewer emergency-room visits for those patients.
Psychiatric medications are more difficult to assess.
There is also more variation in mental-health medications. Cost, quality and access Efforts to control cost have often resulted in defining access. Access to hospital services is defined by how long patients can stay in a hospital. Access to physicians is limited by defining which physicians patients can use if they enroll in a specific health plan or by having patients see primary providers first. Access can also be defined in terms of quality.