Cost containment--another view.

There is an emerging public consensus that in a slowly growing economy, the continuing rise in the nation's health-care costs must be moderated. Ginzberg has suggested that we can and must do this without reducing the quality of care we provide and without major changes in the structure or governance of our health-care-delivery system. He implies that we can readily identify and eliminate substantial numbers of useless health-care services. Such an approach to cost containment is almost certain to fail. A successful cost-containment program will include some or all of the following elements: caps on public health expenditures and implicit limits on the quality and accessibility of health care to be provided at public expense, much tighter government regulation of private health-care expenditures, control of the physician supply, and modification of the fee-for-service reimbursement system for physicians and hospitals. Until our society is prepared to accept these kinds of structural changes and their adverse impact, to some degree, on the quality and accessibility of health services, effective cost containment will not occur. Are we ready for these kinds of changes? Should we be? Perhaps we ought to be less concerned about cost containment and more prepared to spend 12 or 13 per cent of the gross national product on health care by 1990. What we should not do is pretend that painless cost containment is an achievable goal.