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Observations Yankee doodling

Great health care, guaranteed

BMJ 2007; 334 doi: (Published 24 May 2007) Cite this as: BMJ 2007;334:1086
  1. Douglas Kamerow, former US assistant surgeon general and the BMJ's US editor
  1. dkamerow{at}

    A 90 day guarantee on surgery may be the first step to improving quality outcomes in the USA

    The front page story in the New York Times on 17 May ( was about a healthcare system in Pennsylvania that has been giving a 90 day guarantee on its coronary artery bypass surgeries since February 2006. For a fixed price, patients get the operation, postoperative care, and any necessary follow-up treatment, including rehospitalisation and even repeat surgery. There are no extra charges. This is news in America, where we are used to unit pricing in health care. That generally leads, of course, to a perverse incentive: if you do a poor job and extra care is needed, you get paid more.

    The newspaper likened the surgical guarantee to a warranty on a new car or a home appliance. The healthcare system, Geisinger, guarantees that all will go well or it will fix the problem, at no additional cost to the purchaser . . . er . . . patient. I generally don't like using the term “consumer” for patients, but in this case it seems appropriate. The customer …

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