Life, Death, and the Dollar Sign

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Abstract
A NEW set of abbreviations is rapidly becoming part of the practicing physician's vocabulary. DRGs, HMOs, PPOs—the letters that denote the strategies developed to contain rising medical costs also connote a profound and rapid shift in the manner in which medical care is delivered. The extent to which these abbreviations pervade the medical and lay press leaves little doubt of their certain effects on the routine practice of medicine. However, these proposals also have the potential to insidiously alter the factors considered in making life-and-death decisions for individual patients. That these difficult decisions on whether to withhold or provide costly life-sustaining support may be based strongly on financial considerations may soon become a realistic possibility, if not a probability. How does one factor life and death in the new ledger of economic restraint? Cost-containment mechanisms will not only strain the financial acumen of physicians and medical administrators but may test

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