At the beginning of the 20th century, the American population was primarily made up of children and young adults, and medical care was cheap, generally ineffective, and focused on acute illness. Health care, resource allocation, and priority setting were not issues. In the 1990s and beyond, most medical care will be provided to a growing population of elderly patients with chronic diseases. Neither health care professionals nor health care planners nor economists appear to be able to deal with the now-dominant issue in health policy, ie, the rising costs of, and seemingly insatiable demand for, medical care. At the same time, complex ethical, medical, and economic subplots arise that are forcing a rethinking of the very goals of medicine. Is there provision of too much care, the wrong kind of care (eg, crises-based acute care vs long-term care vs prevention), or care for the wrong patients (ie, the irretrievably ill
WEBSTER JR, BERDES C. Ethics and Economic Realities: Goals and Strategies for Care Toward the End of Life. Arch Intern Med. 1990;150(9):1795–1797. doi:10.1001/archinte.1990.00390200009002
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