Suppose you want to order lunch. Pizza A and pizza B both taste good. Naturally, you choose A for its lower overall price. In medicine, delivery costs depend on the efficiency of process flows at provider institutions. This is difficult to measure, in part, because few people study this area.
Most research focuses on the cost of the clinical procedures themselves.
HMOs generally have no handle on runaway delivery costs either. Instead, they control overall cost through capitation and overseeing physicians' clinical decisions. That is like pizzeria owner B ordering the cook to scrimp on pepperoni because he does not know how to cut delivery costs, say the authors. Providers and HMOs currently talk past each other. Cost constraints have compromised quality and will do so further, but at the same time, the HMOs' charges about waste are also true.