The Context of Health Care in the United States

In preparation for the inevitable, plans must be made and the techniques developed for the effective allocation and rationing of health care resources ( Evans 1983).

Economic incentives such as those embedded in current cost-containment measures are not a substitute for social decisions about health care priorities and the just design of health care institutions.... These hard choices must be faced publicly and explicitly ( Daniels 1986:1383).

Unless we decide to ban heart or liver transplantation, or make them available to everyone, some rationing scheme must be raised to choose among potential transplant candidates ( Annas 1985:187).

It is in high technology areas where we face the stark reality of patient need against scarce resources in life and death situations that we see rationing with all its sharp edges exposed ( Mechanic 1986:217).

It is becoming increasingly clear that major alterations in the health care system of the United States will be necessary in the coming decades if we are to avert a crisis of immense proportions. Many seemingly unrelated demographic, social, and technological trends in actuality constitute a concatenation that promises to accentuate traditional dilemmas in medical policymaking. The aging population. the proliferation of high-cost biomedical technologies designed primarily to extend life, conventional schemes of retroactive reimbursement by

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Rationing Medicine
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Preface ix
  • Acknowledgments xi
  • The Context of Health Care in the United States 1
  • Critical Health Care Issues 39
  • The Allocation and Rationing of Medical Care 77
  • The Role of Government Institutions 135
  • Prospects for the Future: Making the Hard Choices 189
  • References 253
  • Index 275
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