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Attempts at controlling costs and fees in a medical center setting.

In 1915, Drs. C. H. and W. J. Mayo established Mayo Foundation to return the patient's dollar to future patients through education and research. Mayo Foundation receives all net earnings from the Mayo practice. In keeping with the ideals of the founders, all patients seeking care at Mayo Clinic are treated regardless of the cost and no one is asked for financial accountability before treatment. It is believed that there should be no financial benefit to any staff member beyond reasonable compensation, or return to the institution beyond what will safeguard its future. All physicians at Mayo are salaried. There is no profit sharing and the staff is not permitted to enter into professional activity outside the institution for pay. We are convinced that quality should not be sacrificed for economy. Rather, economy must be sought through efficiency and through discriminating use of medical services and technologies. Mayo has long sought to control costs in this manner. The organization of Mayo practice and the relationships with its two affiliated hospitals have helped to make this approach possible. The practice of medicine at Mayo is primarily an outpatient practice. Only 20 percent of patient registrations over the last 30 years have resulted in hospital admissions, and only 5 percent of these before evaluation as outpatients. This percentage has remained constant to the present time, in spite of rigorous hospitalization review in recent years. For many years, Mayo has tried to use the skills of paramedical workers to free the physician from tasks that do not require his skills and knowledge. This results in some savings to patients. Since many Mayo patients come from a distance to Rochester, the