The limits of health care resources.

Abstract

The United States has’ limited facilities, personnel, and equipment to prevent, diagnose and treat illness and injury. There will never be an adequate supply of these resources to do everything for everyone; there never has been. “Thus,” as Lundberg says, “care is rationed every day but in irrational ways.“’ De facto rationing has physicians, government, administrators, or society allocating resources to problems they each see as most crucial. If the allocation of health-care resources has always existed, why is it suddenly a “hot” topic? The sudden increased concern over resource allocation is due to the rise in the medically needy population and the phenomenal increase in health-care costs over the past 25 years. An aging population, the emergence of AIDS as a high-cost epidemic, decreasing availability of employersupplied health insurance,* and a depressed economy have increased the number of medically needy in the United States to more than 37 million people. By 1988, the US Bureau of the Census found that 63.9 million Americans lacked health insurance coverage for at least 1 month in the prior year,3 and estimates are that about one fourth of the US population are uninsured or inadequately insured for medical treatment costs.4 The increase in health-care costs only add to this problem. In 1965, we spent approximately 6% of our gross national product on health care; in 1975, we spent approximately 8%; in 1985, we spent approximately 10.5%; and in 1990, we spent over 12%-approximately $700 billion5 From 1977 to 1987 health-care expenditures rose at an average annual rate of 3% in real terms.6 It is estimated that by 1996 annual US health-care spending will reach $1 trillion.’ By the year 2000, if we continue on this course, we will spend approximately 15% of our gross national product (GNP) on health care.6 So far, the patchwork solutions or putatively curative new health-care delivery systems have not noticeably improved the situation.