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To the Editor: Drs Herzlinger and Parsa-Parsi¹ attribute the success of the Swiss system to its resemblance to a consumer-driven system. However, Dr Reinhardt² points out that the resemblance is distant, at best. He notes that the Swiss system is more like "managed competition" than consumer-driven care and that there are many other plausible reasons why Switzerland seems to be doing much better with health care than the United States.

I agree with Reinhardt that the argument of Herzlinger and Parsa-Parsi is unconvincing. The fact is that consumer-driven health care, as recently advocated by Herzlinger³ and others, is just a theory that has not yet been tested on anything like a national scale. To proponents of market-based health care, a consumer-driven system looks like just what we need. However, in health care, it usually turns out that "empowering consumers" is just another way of shifting the cost burden to . . . [Full Text of this Article]

Arnold Relman, MD
arelman@rics.bwh.harvard.edu
Harvard Medical School
Boston, Mass

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