Contrast this with “real disase care and we see that there is, indeed, a significant amount of care that is rendered that has little bearing on medical outcome, but the underlying rationale for that care is much more complex and is qualitatively different from Worker’s Comp. To be sure a physician who owns an MRI has an inescapable incentive to order an MRI. But what are we to make of the fact that the overwhelming majority of MRI’s ordered (pick a number–80, 90,95%) are ordered by physicians who will not receive any reimbursement for ordering the test. Why is this care ordered? And why does the patient follow through?

Simple. The patient is insulated from the economic effect of the test because of the pre-paid service contract she thinks is insurance, and therefore has no financial disincentive. The physician is so fearful of a malpractice tort that there is simply no amount of care that she can order that is enough is the next order might be the one to prevent the tort. Unlimited demand on both the patient and the provider sids equals infinite cost.

Contrary to Mr. Padua’s conclusion there is nothing in that study that is remotel referrable to the non-Worker’s Comp world.