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The Painful Prescription: Rationing Health Care

Arch Surg. 1984;119(11):1353. doi:10.1001/archsurg.1984.01390230115035.
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This scholarly, well-documented, thought-provoking study by a medical-care economist and an experienced physician is in the valuable tradition of the Brookings Institute, and is directed at a problem of current societal importance. The comparison of medical-care patterns and costs in the United States with those in England presents a scenario of what the United States can anticipate when (not if) medical-care expenditure is budgeted and selection is necessary as to what care can be afforded and what care can be omitted because it is societally cost-effective.

The first 78 pages emphasize some compelling data. Compared with the United States, England shows the following (per capita) differences: 12% fewer acute-care hospital beds (and much larger patient waiting lists for elective and low-yield problems); 67% fewer doctors; 70% as many intensive care unit (ICU) beds; 25% longer hospital stays; 5% to 6% of the gross national product devoted to medical care, v


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