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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


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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