Controlling Costs: The Case of Kaiser-Reply

Abstract

In Reply. —Dr Zendle doth protest too much. First, we are not sloppy about our data. The Kaiser Permanente Medical Care Program, Southern California Region, operates 12 MRI scanners for an enrolled population of about 2.2 million people, or a ratio of 5.5 MRI scanners per 1 million enrollees. For the United States as a whole, 1 the supply of MRI scanners is 11.2 scanners per 1 million population—twice the level found at Southern California Kaiser Permanente. This said, far from intending to malign Zendle and his colleagues, we interpret these figures as a compliment to Kaiser Permanente's rational approach to regionalizing technology. While we applaud development of evidence-based guidelines for clinical practice, guidelines alone have not been shown to have resounding success as a cost-containment strategy. Reasonable constraints on capacity encourage more prudent use of services. Within the boundaries defined by available supply, practice guidelines may serve a useful