In some cases these HMO's go to great lengths to save money. For instance, some HMO doctors are forced to sign a "gag order," which forbids them to advise their patients about expensive medical care which their HMO does not want to pay for. Doctors may actually be penalized by their HMOs because, in violation of a gag order, they discussed with their patients the option for a procedure the HMO did not want to pay for. In some instances HMOs give their doctors financial bonuses for not ordering tests or referring their patients to specialists. Some HMOs pay doctors according to a "withhold" system, in which some of the money the doctors are owed is held back and paid only at the end of the year, and only if the doctors have not ordered too many tests or referred too many patients to specialists ("Did You Know"). .
HMOs are not the only answers to cost control. Most physicians practicing in the United States consider their profession to be very much a form of art (Kleinke). The definition of art infers that within its sphere there are many variations and preferences. After all, one should not ask Picasso to carve like Michelangelo. Physicians too differ in their methods of treating patients. However when needless tests and procedures are done the treatment will cost more. This is waste. Many suggest that cutting waste will lead to a cut in quality. This is not necessarily true. Consider the following: an otherwise healthy forty-year-old male comes to a clinic complaining of a sore throat. This is a typical nonspecific symptom, so naturally some tests are done. Blood is drawn, a culture taken, and an electrocardiogram performed. An EKG in this case is not medically necessary, but many physicians still do not hesitate to order one. By eliminating useless procedures, lower cost can be maintained. To determine which procedures are useless, scientists would need to perform ongoing studies of patients that fall under their investigative categories.
