Allocating health resources.

摘要: Allocating Health Resources I have spent many months now trying to answer a simply stated, reasonable question: How can the United States devise health policy that provides adequate care at an affordable price? To ask such question is not indicatable offense. But it also, conclude, designed by specialist in exotic forms of torture. The American system, and public attitudes support it, are vast arena confusion, contradictions, conundrums. Imagine some muddled cook once conflated recipes for beef stew, bouillabaisse, chocolate cake. Your task take concoction make edible dish. further you been assigned numerous subchefs your choosing, each whom has different tastes, allegedly on payroll beef, or fish, industries, all strong-willed prone state their convictions language high morality. If analogy seems strained, scanning recent headlines, examination new opinion surveys, tour through number books may give more credibility. Failure Cost Containment These from New York Times early 1988: * "Prepaid Programs Care Encounter Snags--H.M.O. Shakeout Seen" "Outpatient Strategy Fails Cut Costs" "Hospitals' Medicare Profits Drop; Decline May Curb Access Care" "Insurance rates Increase Sharply...Premiums Rise 10-70%, with up 38.5%--Setback Seen That last, wonderfully understand phrase "Setback worth closer look. Consider beginning 1970 Nixon administration continuing into Carter Reagan eras, "cost containment" crusade. In context, these headlines tell us something great importance about most prominent strategies control costs. They us, instance, H.M.O. movement having trouble controlling costs is, as consequence, growing originally hoped. indicate rising hospital patients undermining efforts keep hospitals solvent. show belief lower outpatient confounded. And they ominously, general remain rise uncontrolled. Those moreover, isolated items. A strong consensus emerged among economists over past couple years cost-containment effort failure. Not one major initiatives yet succeeded--or shows any serious promise will eventually succeed. even slightest downward dip significance appeared those economic charts measure ever-rising cost care. Relative pace inflation general, actually increased few years. failure important implications. One loose talk simple feasibility "cutting fat" system should cease. logical possibility waste be controlled confused pragmatic probability be. Nor assumed reduction inefficiency proceed rapidly than cost-escalating power constant technological innovation. What call "intensification services"--a greater use technology individual patients--accounts 20 25 percent annual inflation. Another implication would utterly naive continue invoking "efficiency" way denying we must openly discuss coming need rationing limits. "Cutting was meant magic bullet save painful choices. …