What is Appropriate Care?

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Abstract
In virtually all industrialized nations, the past decade has brought unprecedented scrutiny of the processes and outcomes of medical care, even as private and public payers press for further cost containment. An old management-consulting adage reads: “Good, fast, cheap: pick any two.” In health care, the contemporary equivalent seems to be: “Quality, accessibility, affordability: have all three.”This management revolution in medicine has gained legitimacy from countless studies showing inexplicable variations in what physicians do and how effectively or efficiently they do it. However, the Achilles' heel of managed care is mounting public and professional concern that quality has been . . .