Cost of medical care: Whose money are we talking about?

There has been a significant effort over the last 10 years to attempt to control the rate of increase in the cost of medical care. However, as is true of any economic system there are multiple stakeholders involved and often competing motivations. The single largest source of medical inflation is the cost of pharmaceuticals, however this topic will not be directly discussed in this paper. Similarly, the cost of medical insurance products will not be included as these issues cannot be directly addressed by physician behavior. The body of this discussion will focus on costs directly experienced by, or potentially controlled by physicians. These areas include: Practice expense and margin; hospital direct costs and margin. It is essential for physicians to fully understand factors they can potentially control and areas they may be able to influence in this troubling era of cost containment.