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JAMA. 1999;281:99.

The Medical Student JAMA is pleased to announce its fifth annual essay competition for medical students, sponsored by the John Conley Foundation for Ethics and Philosophy in Medicine. This year's topic examines an issue raised by the growing importance of cost containment in medical practice.

Traditionally, optimal patient care has been the foremost concern of medicine. More recently, physicians are facing pressures to restrain health care expenditures, presumably without sacrificing the interests of the patient. In their essays, medical students are asked to address the following scenario: Suppose a potentially useful procedure is available that is not covered by a patient's medical insurance. Under what circumstances, if any, would you consider it appropriate to miscode (and thereby make available) the needed procedure? See the November 1998 MSJAMA, p 1534, for complete details.

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