Academic Group Practice

To the Editor: Table 1 lists the findings of Cohen et al. (June 12 issue)¹ along with the findings of two recent studies that also examined the effects of specific organizational changes on the use of medical services.^2,3 In all three studies the marginal cost of the intervention was small. Table 1 provides additional evidence that, as Cohen et al. contend, organizational effects can have important cost implications. If capitation were the major source of funding, cost savings might provide an impetus to reorganize medical care. However, both investor-owned and not-for-profit hospitals have high charge-to-cost markups for ancillary services⁴ — services that were substantially.