Published In: JAMA, The Journal of the American Medical Association, v. 308, no. 12, Sep. 26, 2012, p. 1219-1220
Discussing care at a university hospital and a VA hospital, it is a story of the fee-for-service vs limited-budget worlds. Efficient care isn't necessarily less expensive care. At the VA there is some operational sluggishness, but also strategy that seems enlightened. The university hospital's situation is not quite the converse, but its strategy seems limited to the universe of problems that it chooses to tackle. If the VA were more nimble, it would be better. If the university hospital were accountable for the lifetime costs of each patient's care, it would be better. Each system has something to offer the other.