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William J. Meggs, MD, PhD
Bethesda, Md

JAMA. 1987;257(23):3227.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In the Jan 9,1987, issue of JAMA, Block et al¹ describe a hospital experimental payment program in Rochester, NY, in which area hospitals operate under a community-wide payment cap. The authors state that "a community-wide assessment showed no evidence of a reduction in the quality of or access to care," but admit that "this conclusion is reached advisedly in view of the limitations of the methodology used to assess the level of care in the community." I viewed this experiment for three years from the perspective of a resident in internal medicine at a hospital covered by the program, and my opinion is that care was greatly compromised. The system in Rochester could best be called the "Irrational Rationing System of Medical Care."

The number of open heart surgeries performed was determined not by the number of patients needing surgery, but by a board that set . . . [Full Text PDF of this Article]

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