Evans R W
JAMA. 1983 Apr 15;249(15):2047-53.
Increasingly, it is recognized that resources available to meet health care needs are limited. Recently, this has been evidenced by reductions in federally funded health care programs and the leveling off of research funds made available to the National Institutes of Health. The problem of severely constrained resources is likely to become more acute, given new medical technology and the high cost of medical care. It is now apparent that both resource allocation and resource-rationing decisions will become inevitable, since not all persons with catastrophic or complicated medical conditions will be able to benefit from medical technology. While the careful assessment of health care technology can conceivably increase the efficiency of the health care delivery system, the methods by which allocation and rationing decisions are made must be improved. In doing so, it will ultimately be essential for this society to come to grips with life and death issues in a manner to which it is not accustomed.
人们越来越认识到，可用于满足医疗保健需求的资源是有限的。最近，联邦政府资助的医疗保健项目的削减以及国立卫生研究院可用研究资金的持平就证明了这一点。鉴于新的医疗技术和高昂的医疗成本，资源严重受限的问题可能会变得更加尖锐。现在很明显，资源分配和资源配给决策将不可避免，因为并非所有患有灾难性或复杂医疗状况的人都能从医疗技术中受益。虽然对医疗保健技术进行仔细评估可以提高医疗保健提供系统的效率，但做出分配和配给决策的方法必须改进。这样做时，对这个社会来说，最终以一种它不习惯的方式来应对生死问题至关重要。
