Clinical decision making: from theory to practice. The individual vs society. Resolving the conflict

Eddy argues for reform of the American health care system. In seeking health coverage, he explains, there are two positions: the first, that of society, seeks to allocate services efficiently; the second, that of the patient, seeks to optimize individual patients' care. Using his illustration of breast cancer coverage from a previous JAMA article (1991 Mar 20; 265 (11): 1446+), Eddy contends that a tradition of decision-making from the second position is the root of present health care inefficiencies. Eddy's ideal would be complete information to physicians and patients about service costs, benefits, and financial feasibility, and an agreed-upon standard of fair resource allocation, based on the threshold of a specific measure of benefit per resource. To approach this ideal, he concludes, we must recognize the problem, pursue education about service costs and benefits and people's desires of the system, and identify and review services that presently are inefficiently utilized.