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 Our study was directed at the big picture or more global concept of improving our basic understanding of physician reimbursement and how it impacts practice behavior. We hope that our controlled, prospective study will be the first of many such studies and literature reviews that will help to focus the pediatric community on finding ways of providing economically efficient high quality care to more people under circumstances of rapidly increasing medical inflation and community/governmental cost cutting. Asking patients who were chronically behind on their bills to obtain care at Metropolitan Nashville General Hospital (which was staffed by Vanderbilt residents and attending physicians) did not impact the health of such patients and was necessary for the study to serve as a model of the way the great majority of pediatrics is practiced in this country.