I spent seven months in the United States as a Harkness fellow, observing the healthcare system. I became aware, among other things, of the power that American physicians have to induce demand for their own services: it is frequently observed that, in those areas of the US where physicians are relatively numerous, the cost of medical outlays is relatively high. Consumer expectations also contribute to increasing the cost of medical care in the US. Many American citizens with minor respiratory illnesses would expect, and would receive, a throat swab and a chest X-ray before antibiotic treatment, whereas in this country most consumers would receive and accept reassurance that the illness was likely to be self-limiting.
As far as cervical screening is concerned, neither the US annual nor the UK quinquennial screening program seem to fit the persuasive epidemiological evidence, which supports three-yearly screening.
KIERAN G. SWEENEY
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