Why do doctors so rarely talk to patients by phone or e-mail?  When use of the computer is ubiquitous among other professionals (accountants, lawyers, architects, etc.), why do so few doctors maintain their patient records that way?  Why do so many doctors prescribe medicines without knowing what they cost?  And even when they know about generic substitutes, why don't they know those costs, or where patients might shop for drugs to get the lowest price?  In an essay for Health Affairs Online, John Goodman explains all these problems are a direct result of the way doctors are paid. 

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http://cdhc.ncpa.org/commentaries/what-is-consumer-directed-health-care 

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http://www.ncpa.org/email/hlthaff.25.w540v1.pdf