Many doctors here have set up clinics. They have the most modern equipment. There are so many angles to this business we call Health Care.

I was very interested to see that the world-renowned Mayo Clinic was controlled by its physicians, with CEO tenure strictly limited to avoid the tendency toward management dynasties.

As for equipment- facilities need to attract physicians and if you don't have the latest equipment they want, they'll take their patients to your competitor across town.

But that's not the biggest cost IMHO. If you look at care delivery, typically the largest expense by far is "people" cost = salaries and physician payments. So to make serious savings you need to pay people less, or have fewer of them. You can't have fewer physicians because they're the ones who bring in the patients, so you'd need to go after nurses, domestics, radiographers etc etc. How brave do you feel? ;-)

Once I remember a new manager announcing he planned to save 10% costs by reducing resident medical salaries. I pointed out that those salaries are only around 3% of total cost so if you paid them nothing, you'd still only save 3% so perhaps he should look elsewhere for his 10% saving. Still he continued making the claim which was very well-received by the sort of person who believes that all doctors are rich fat-cats, confirming that healthcare management behavior is often more political than sensible.