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Article
July 27, 1994

Health System ReformWill Controlling Costs Require Rationing Services?

Author Affiliations

Duke University Durham, NC

JAMA. 1994;272(4):324-328. doi:10.1001/jama.1994.03520040088055
Abstract

UNFORTUNATELY, it will.

Because that is such an unpleasant thought, it is important to examine each link in the supporting chain of reasoning. As the case for rationing tightens, there will be a tremendous temptation to go back and question the underlying premise. Therefore the first question is:

DO WE REALLY HAVE TO CONTROL COSTS?  Yes, we do.Although virtually everyone agrees that health care costs are a problem, it is worthwhile to review a few of the facts that indicate just how bad the problem is. Begin with the fact that for the last few decades health care costs have been increasing at a rate of about 11.5% a year.1 This is far faster than other sectors of the economy, with the result that health care has steadily grown as a proportion of the gross domestic product (GDP), from about 5% in 1960 to about 12% in 1990.

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