ABSTRACT
Health care payers, not providers or patients, are in the financial driver's seat these days. Their demands for cost containment have been heard loud and clear by competing health plans, and a real slow down in the rate of premium increases occurred between 1994 and 1996. Costs can be attacked from two sides. The more obvious one, which dominates public perceptions, health economists' "solutions", and health plan actions, starts from the financial side. Inappropriate care raises health care costs needlessly. This is true whatever the degree of inappropriateness: care that does harm; care that does no harm but is ineffective; care that is effective but costs more than an alternative, equally beneficial treatment; or care that is simply unnecessary. One cost-increasing expectation that means little medically but a lot in terms of patient satisfaction is that the amenities of care, especially when hospitalized, will be preserved at the highest standard.
