Abstract
It is virtually impossible to practice "cost-effective" medicine in today's complex hospital environment. There are simply too many diagnostic and therapeutic issues to be considered, too many tests and procedures that can be employed, and too many constraints on the ability to treat patients with severe multisystem diseases. These problems are compounded by the crazy-quilt pattern of organization of the hospital ward units, Byzantine administrative lines of authority, conflicting advice from subspecialists, enthusiastic marketing by the device and pharmaceutical industry, and confusing methods of reimbursement. Even the compound word<i>cost-effective</i>has a variety of meanings depending on who benefits. It could mean the bottom line of hospital profitability, or it could mean the costs to third-party payers, or it could mean the most efficient use of resources for patient management. See also p 1720. In the era before the advent of diagnosis related groups (DRGs), there were few incentives for
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