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This article examines the tension between the medical profession's control of medical decisionmaking and the decentralization strategy of placing control of costs and decisions in consumers' hands. The author argues that society cannot fight the battle for efficiency in medical care because the professional paradigm limits the ability of consumers to influence physicians' practices. He explains the paradigm as the medical profession's belief that medical care is not a consumer good but is scientifically determined, and thus medical decisions are entrusted exclusively to physicians. The author analyzes the operation of the professional paradigm in the following areas: accreditation, hospital organization, payment for medical care, malpractice law, and practice guidelines. The author maintains that decentralization is achievable in each of these areas and would be beneficial to society.

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