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Previous Volume 298:249-254 February 2, 1978 Number 5 Next

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Abstract

Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.

This article has been cited by other articles:

• Mechanic, D. (1995). Dilemmas in rationing health care services: the case for implicit rationing. BMJ 310: 1655-1659 [Full Text]  
• Mechanic, D. (1993). America's Health Care System and its Future: The View of a Despairing Optimist. Med Care Res Rev 50: 7-48  
• Hale, F. A., Nelson, E. C., Gephart, D. S., Stone, K. C. (1982). Education: Use of an Interpractice Medical Information System to Develop a Data-Based Clinical Cost-Consciousness Curriculum in Primary Care Settings. Med Decis Making 2: 217-223  
• Saward, E, Sorensen, A (1978). The current emphasis on preventive medicine. Science 200: 889-894