Medicare reimburses physicians three to five times more for common procedural care than for cognitive care (the main professional activities of primary care physicians), and these financial pressures may be a contributing factor to the U.S. health care system's emphasis on procedural care, according to a study by Christine A. Sinsky, M.D., of the Medical Associates Clinic P.C., Dubuque, I.A., and David C. Dugdale, M.D., of the University of Washington, Seattle.