When the last of those hospitals closed in the early 1980's, many doctors were forced to use hospitals far from the neighborhood.

Annual deductibles increased to $561, on average, from $488 in 2002, for using doctors or hospitals outside a health plan's network.

"I think we use hospitals far too much," she said.

A smaller version of that program, which forced people to use public hospitals in exchange for low-premium insurance, failed.

Doctors should use hospitals that best meet medical needs.

People who use hospitals outside the ghettos figure they will always be taken care of.

New York has also used hospitals more intensively than elsewhere.

Another option is to buy a recently introduced type of Medigap policy that costs less if a person uses certain hospitals.

Patients can use other doctors and hospitals, but must pay more, sometimes much more, when they do so.

Or should they choose a health-maintenance organization, which provides comprehensive medical services to members who agree to use the organization's doctors and specific hospitals?