Markets, budgets, and health care cost control.

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Health care cost control is often debated in terms of markets versus bureaucracies. Market restraints are limited in practice by the goal of providing access to care. Therefore, effective cost control requires budgeting. Experience from budgeting for other services should put health care cost control in perspective: The goal should not be rational and efficient allocations, merely better ones. The important choice is not between markets and bureaucracy, but rather which decisions should be made by physicians and which by budgeters, and how to ensure that professional judgment is applied where most important.