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Controlling healthcare costs by removing waste: what American doctors can do now
  1. Stephen J Swensen1,
  2. Gary S Kaplan2,
  3. Gregg S Meyer3,
  4. Eugene C Nelson4,
  5. Gordon C Hunt5,
  6. David B Pryor6,
  7. Jed I Weissberg7,
  8. Jennifer Daley8,
  9. Gary R Yates9,
  10. Mark R Chassin10
  1. 1Mayo Clinic, Rochester, Minnesota, USA
  2. 2Virginia Mason Health System, Seattle, Washington, USA
  3. 3Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Massachusetts, USA
  4. 4Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  5. 5Sutter Health, Sacramento, California, USA
  6. 6Ascension Health, St Louis, Missouri, USA
  7. 7Quality and Care Delivery Excellence, Kaiser Permanente, Oakland, California, USA
  8. 8University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
  9. 9Sentara Healthcare, Norfolk, Virginia, USA
  10. 10The Joint Commission, Oakbrook Terrace, Illinois, USA
  1. Correspondence to Dr Stephen J Swensen, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA; swensen.stephen{at}


Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes. These challenges know no borders.

  • Healthcare quality
  • patient-centred
  • pay for performance
  • quality of care

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.