for abdominal aortic aneurysm following a negative study or screening low risk individuals for hepatitis B virus infection. Routine low back pain imaging is another area of overutilized imaging. To curb future costs, it has also been proposed to include stewardship of resources (avoiding the overuse and misuse of diagnostic tests) as a general competency of the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties for residency training and evaluation.12 Value based insurance design and personalized medicine are other methods being touted as solutions to bending the cost curve and reducing overutilization. Physician-owned facilities In one report that identified the influence of the location of care delivery on SID, it was found that physicians were more likely to treat the low-severity patients at their physician-owned facility rather than to increase the overall number of procedures that were done in the population in order to increase revenue. Geography Variation may also exist from regional or local community practice, and utilization of healthcare services can vary widely. McAllen, Texas, is one of the most expensive healthcare markets in the U.S., where in 2006 Medicare spent $15,000 per enrollee here, which was almost twice the national average. Direct-to-consumer advertising Three out of four patients who ask a physician about a particular medication have that medication prescribed to them because they saw advertising for it. This results in a change in prescribing habits such that a physician will prescribe the more expensive requested medication rather than a lower price generic alternative. Advertising for cosmetic surgery services can influence patients and physicians, extending even into the area of cosmetic gynecology where outcomes are unproven. Internationally, countries with fixed-fee universal healthcare systems such as those in Scandinavia are not shown to engage in supplier-induced demand profiteering. Norwegian contract physicians’ gross revenue and profits were found to be declining functions of physician density despite more than half of all Norwegian physicians receiving payouts on a fee-for-item basis. Additionally, in Japan where hospitals are required by law to be run as non-for-profit organizations run by physicians, it was found that increases in medical charges both in clinics and hospitals are associated with higher density of physicians. The clinical benefits gained by patients with a higher level of medical charges was however not measured and must be investigated in order to determine the extent to which supplier-induced demand plays a roll in this relationship. Ethical concerns The