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Competition, innovation and the Sorceror's Apprentice
Written by Jeffrey R. Waggoner, MD   
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In the heated debate over how American health care should be reformed, the inadequacies of a system such as Great Britain’s NHS are often used as proof of the failure of a national health care system. The risk of such reasoning is that it fails to define the cause for those inadequacies.

In a system of supply and demand, efficiency is contingent upon innovation by the supply side. Innovation is driven by competition.

For example, when the demand side, i.e. consumers, made it clear that they really wanted their own personal computers, within two decades the supply side had innovated, cutting cost, increasing computing power and running out cheap, powerful, and eventually ubiquitous desktops. When the demand side suggested that it would like having a computer that could be carried around, the supply side panted a couple of times, then it geared up and kaboom—behold a laptop.

In health care, the supply side is comprised of doctors, hospitals, physical therapists—those who deliver the service of caring for patients. For 60 years Great Britain’s supply side has not had to compete. Rewards accrued regardless of how medical services were delivered. Without competition, innovation was regarded with a yawn and a nod of the head.

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Pay for Performance: Will It Make a Difference?
Written by Ardena L. Flippin, MD, MBA   
Dr. Ardena Flippin

The intent of Pay-for-Performance (P4P) seems to be payment to encourage certain behaviors.  I think that the majority of physicians practice good medicine and have adapted to the behavioral demands of increased documentation of what we ordinarily do as medical caretakers. Is documenting services rendered documenting health?

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Potential and Problems of E-Prescribing
Written by Patricia King   

e-prescribingFor several years, health care industry experts have urged physicians to adopt electronic prescribing, to improve quality and contain health care costs.  Nevertheless, adoption of e-prescribing technology lags; in 2005, the U.S. Dept. of Health and Human Services estimated that fewer than 18% of physicians used the technology [1]. Are physicians not sold on the benefits of e-prescribing? If physicians do believe that e-prescribing is beneficial, what accounts for the low rate of adoption?

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