Making sense of medical technology

Abstract

In seeking to explain contradictory reports that increased medical spending is both valuable and wasteful, Jonathan Skinner and colleagues rightly emphasize differences in regional practice patterns in response to constraints. However, it is more accurate to view the situation not as a choice between valuable but inexpensive care and more costly care with worse outcomes-as Skinner and colleagues theorize-but as a choice between responses to regional inefficiencies. Given that we do not know what will best improve the efficiency of medical care in a given area, experiments with financial incentives to both providers and individual patients should receive high priority.