NASHVILLE--Health-care costs may not yet be taking a large enough
chunk out of national expenditures to inspire drastic health-care
reform, Mark Chassin, MD, said at a forum on health-care reform
at the American Society of Hematology (ASH) meeting (see "ASH Panel: How many Hemotologists/Oncologists Are Enough?").

But since such reforms are inevitable, he said, hematologists
should be taking steps now to deal with them, most notably, quality
control measures.

Currently, he said, 14% of the national wealth is spent on health
care, but medical care costs are going up at about double the
average rate of inflation. Dr. Chassin suggested that medical
expenditures for 1994 may reach a trillion dollars, with the second
trillion added in about 7 years, if medical costs keep expanding
at 10% a year.

"At some point on this upward curve, those costs become unsustainable,
for everybody," he said.

When that occurs, he said, drastic measures to control costs will
be taken at the expense of health-care access and quality. The
measures already being instituted--shifting costs to patients
by increasing deductibles and copayments, restricting freedom
of choice--are a "blunt instrument," he said, that throws
up barriers to patients in need of care. He went so far as to
say that such cost-cutting measures are a "hazard to health."

Quality-Driven Approach

The health-reform strategy Dr. Chassin prefers is a quality-driven
approach that has been used in New York State, where he served
until recently as commissioner of the Department of Health, to
rein in the costs of cardiac surgery. This approach relies on
strategies that selectively reduce the use of inappropriate or
unnecessary health services, while preserving access to necessary
and effective care.