Perverse Incentives, Statesmanship, and the Ghosts of Reforms Past
Authors: Peter E. Dans
Journal: Annals of Internal Medicine (1993)

Editorials1 February 1993Perverse Incentives, Statesmanship, and the Ghosts of Reforms PastPeter E. Dans, MD, Deputy EditorPeter E. Dans, MD, Deputy Editor Annals of Internal Medicine, Philadelphia, PA 19106.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-3-199302010-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We are on the verge of health care reforms aimed at increasing access for the uninsured while decreasing costs. Such reforms will require better integration and deployment of health care personnel and facilities. This will be difficult given the perverse incentives (in many cases, the residues of past reforms). Mirroring societal values, these incentives have resulted in a system skewed toward technologic and subspecialty solutions rather than preventive, primary, and long-term care. If the promise of this reform movement is to be realized, statesmanship will be required at all levels by all concerned.We have entered one of those reform ...References1. Aaron HJ, Schwartz W. The Painful Prescription: Rationing Hospital Care. Brookings Institution. Washington, D.C. 1984. Google Scholar2. Aaron HJ. What's the rush on health care? The New York Times; 14 Nov 1992. 142:p:15. Google Scholar3. Redman E. Dance of Legislation. New York: Simon and Schuster; 1973. Google Scholar4. Dans PE. Physicians and health policy. JAMA. 1980; 243:1451-3. Google Scholar5. Gruenberg EM. The failures of success. Milbank Mem Fund Q Health Soc. 1977; 155:3-24. Google Scholar6. Stoline A, Weiner JP, Dans PE, Geller G, Mussman MG. The New Medical Marketplace. A Physician's Guide to the Health Care Revolution. Baltimore. Johns Hopkins University Press. 1988:6-31. Google Scholar7. Committee on the Costs of Medical Care. Medical Care for the American People—Final Report. Chicago: University of Chicago Press; 1932. Google Scholar8. Thomas L. On the science and technology of medicine. Daedalus. 1977; 106:35-46. Google Scholar9. Fox RC. The medicalization and demedicalization of American Society. Daedalus. 1977; 106:9-22. Google Scholar10. Dans PE, Matricciani RM, Otter SE, Reuland DS. Intravenous drug abuse and one academic health center. JAMA. 1990; 263:3173-6. Google Scholar11. Daniels N. Why saying no to patients in the United States is so hard: Cost containment, justice and provider autonomy. N Engl J Med. 1986; 314:1380-3. Google Scholar12. Etzioni A. Clinton's first job: lobbyists. Philadelphia Inquirer. November 13, 1992:A29. Google Scholar Author, Article, and Disclosure InformationAffiliations: Annals of Internal Medicine, Philadelphia, PA 19106.Corresponding Author: Peter E. Dans, MD, American College of Physicians, Sixth Street at Race, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNow Is the Time: Physician Involvement in Health Care Reform Nicole Lurie , Steven H. Miles , and David K. Haugen Metrics Cited ByPeter Emanuel Dans, MD: A Conversation with the Editor 1 February 1993Volume 118, Issue 3Page: 227-229KeywordsDrug abuseDrug usersDrugsHealth careHealth care facilitiesHealth insuranceLong-term careMedicareMotivationSub-specialty care Issue Published: 1 February 1993 CopyrightCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...