US reimbursement systems encourage fraud and overutilisation.

摘要

Atul Gawande (Dana Farber Cancer Institute, Boston, MA, USA) has made waves with an article in the June issue of the New Yorker, comparing healthcare costs in McAllen, TX-the second most expensive Medicare market in the USA-with a demographically similar but less profligate area. El Paso, TX. McAllen residents do not suffer poorer health or enjoy better healthcare outcomes than residents in El Paso, Gawande writes. But they are far more frequently referred to specialists, imaging exams, and physiological studies, and are two-thirds more likely than El Paso's Medicare recipients to see more than nine specialists in a 6-month period. McAllen consumes twice the US average in per-capita expenditure in Medicare-the federal health insurance programme for the elderly or disabled.