1. Schwartz WB, Mendelson DN. Hospital cost containment in the 1980s: hard lessons learned and prospects for the 1990s. New England Journal of Medicine 1991;324: 1037-42.

2. Calculations based on data from American Hospital Association, Hospital Statistics 1995-96 Edition (Chicago: AHA, 1995); see also Schwartz WB, Mendelson DN. Hospital cost containment in the 1980s: hard lessons learned and prospects for the 1990s. New England Journal of Medicine 1991; 324:1037-42.

3. Managed health care: effect on employers' costs difficult to measure. Washington, D.C.: United States General Accounting Office, 1993.

4. Managed health care: effect on employers' costs difficult to measure. Washington, D.C.: United States General Accounting Office, 1993.

5. Levit KR, Sensenig AL, Cowan CA et al. National health expenditures, 1993. Health Care Financing Review 1994; 16 (1): 247-94.

6. Schwartz WB, Mendelson DN. Eliminating waste and inefficiency can do little to contain costs. Health Affairs 1994;13(1):224-38.

7. American Hospital Association, Hospital statistics 1995-96 Edition . Chicago: AHA, 1995.

8. Calculation based on American Hospital Association, Hospital statistics 1995-96 Edition . Chicago: AHA, 1995.

9. Schwartz WB, Mendelson DN. Eliminating waste and inefficiency can do little to contain costs. Health Affairs 1994;13(1):224-38.

10. American Hospital Association, Hospital statistics 1995-96 Edition . Chicago: AHA, 1995.

11. Audit of Medicare finds $23 billion in overpayments. New York Times 17 July 1997:A1.

12. U.S. contends billing fraud at Columbia was "systemic." New York Times 7 October 1997:C1, C4.

13. Sparrow MK. Health care fraud control: the state of the art . Cambridge: Harvard, 1995.

14. Aaron HJ, Schwartz WB. An ounce of prevention as costly as the cure. Washington Post 16 November 1995:A23.

15. Aaron HJ, Schwartz WB. An ounce of prevention as costly as the cure. Washington Post 16 November 1995:A23.

16. Prager LO. Questions raised about impact of guidelines in Maine project. American Medical News 1996;39(21): 1, 3.

17. Acute pain management: operative or medical procedures and trauma. Rockville, Md.: Agency for Health Care Policy and Research, 1992.

18. Calculations based on data from American Hospital Association, Hospital statistics 1995-96 Edition . Chicago: AHA, 1995.

19. Calculations based on data from American Hospital Association, Hospital statistics 1996-97 Edition . Chicago: AHA, 1996.

20. Aaron HJ. Serious and unstable condition: financing America's health care. Washington, D.C.: Brookings Institution, 1991.

21. Analysts expect health premiums to rise sharply. New York Times 19 October 1997:1, 14.

22. Government worker premiums to rise 8.5%. Hospitals and Health Networks 1997; 71(20):83.

23. Schwartz WB, Mendelson DN. Eliminating waste and inefficiency can do little to contain costs. Health Affairs 1994; 13 (1) :224-38.

24. Data from the Health Care Financing Administration ate used throughout this discussion.