Government revamp of the health care system: effect on patient care and research.

Since the end of World War II, the United States has been in a golden age of medicine. Unprecedented advances in biomedical research have resulted in a fundamental understanding of many disease processes; pharmaceutical research and development has produced a host of new therapeutic agents; and new technology has opened new vistas in the areas of diagnosis and therapeutics. This new knowledge has been translated into the health care delivery system. The federal government made the crucial decision that new hospital construction and increased bed capacity were needed to upgrade medical care in the modern, high-technology era. Another crucial decision made by the government was that health care was a fundamental right of all its citizens, and access to the health care system for the elderly, poor, and middle class had to be assured. This decision was culminated by the enactment of the entitlement programs of Medicare and Medicaid in 1965. These policies helped to decrease the mortality rate of our population by 1.5 percent per year. Our elderly citizens are healthier as a group and living longer. During the past decade strains on the economy secondary to the inflationary spiral produced by the Arab Oil Embargo and the huge budget deficits of the Reagan Administration have led to broad-based efforts to decrease spending on health care. A complex system of cost limits has been initiated, including a prospective reimbursement system for Medicare and Medicaid based on diagnostic-related groups. This system will force hospitals to shift from direct medical care to ambulatory, lower-cost services, making it costlier and more difficult for individuals, particularly the poor, elderly, and middle class, to have access to the health care system.