ABSTRACT
Direct healthcare expenditures for heart disease in the United States in 1998 were nearly $98 billion. The costs attributed to lost productivity, or indirect costs, exceeded $76 billion (1). While advances in diagnosis and treatment of diseases have made medicine in the United States the best in the world, costs have escalated to the point where society’s ability to sustain these costs is being questioned. The past 20 years have seen increasing scrutiny of costs as they relate to medical outcomes. Payers have instituted reimbursement plans, such as the Medicare DRG system and managed care capitation, in an effort to control costs. These plans force healthcare providers to use economics as at least one component of their decision-making process. Economic pressures have pushed organized medicine to focus on “cost-effective care” (2-4).
