The current Medicare operation—reimbursing medical goods and services to a growing number of people without basing the reimbursement benefit on the actual cost of the services—is unsustainable, but there are some possible remedies.
Physicians are cautioned that the two obstacles to reforming post-marketing clinical trials are the FDA's reluctance to revisit past approvals and its inability to enforce pharmaceutical companies' commitment to conduct Phase IV trials.
Physicians can work with their patients to explore less expensive alternatives for delivering health care if physicians welcome the topic of cost during the clinical encounter.
A physicians urges practitioners to use cost-effective alternatives to dispensing samples to patients who cannot afford to pay for their prescriptions.
Professional, practical, clinical and cultural obligations should guide decision making when a funding agency restricts the types of counseling and advice it allows medical professionals to dispense.