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April 15, 1983, Vol 249, No. 15 >
Special Communications | April 15, 1983

Health Care Technology and the Inevitability of Resource Allocation and Rationing Decisions: Title and subTitle BreakPart I

Roger W. Evans, PhD
[+] Author Affiliations

Reprint requests to Battelle Human Affairs Research Centers, 4000 NE 41st St, PO Box C-5395, Seattle, WA 98105 (Dr Evans).


From the Health and Population Study Center, Battelle Human Affairs Research Centers, Seattle.


JAMA. 1983;249(15):2047-2053. doi:10.1001/jama.1983.03330390051031
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References

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.

(JAMA 1983;249:2047-2053)

REFERENCES

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Chalmers TC:  Who will fund clinical trials ? Sciences 1982;;22:6-8.
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Bunker JP, Fowles J, Schaffarzick R:  Evaluation of medical-technology strategies: I. Effects of coverage and reimbursement . N Engl J Med 1982;;306:620-624.
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Bunker JP, Fowles J, Schaffarzick R:  Evaluation of medical-technology strategies: II. Proposal for an institute for health-care evaluation . N Engl J Med 1982;;306:687-692.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Russell L:  How much does medical technology cost ? Bull NY Acad Med 1978;;54:124-132.
2 +
Caper P:  Competition and health care: A new Trojan horse . N Engl J Med 1982;;306:928-929.
3 +
Iglehart JK:  Medicare's uncertain future . N Engl J Med 1982;;306:1308-1312.
4 +
McGregor M, Polletier G:  Planning of specialized health facilities: Size vs. cost and effectiveness in heart surgery . N Engl J Med 1978;; 299:179-181.
5 +
Luft HS, Bunker JP, Enthoven AC:  Should operations be regionalized?: The empirical relation between surgical volume and mortality . N Engl J Med 1979;;301:1364-1369.
6 +
Finkler SA:  Cost-effectiveness of regionalization: The heart surgery example . Inquiry 1979;;16:264-270.
7 +
Iglehart JK:  Health policy report: Prospects for the National Institutes of Health . N Engl J Med 1982;;306:879-884.
8 +
Chalmers TC:  The clinical trial . Milbank Mem Fund Q 1981;;59:324-339.
9 +
Chalmers TC:  Who will fund clinical trials ? Sciences 1982;;22:6-8.
10 +
Bunker JP, Fowles J, Schaffarzick R:  Evaluation of medical-technology strategies: I. Effects of coverage and reimbursement . N Engl J Med 1982;;306:620-624.
11 +
Bunker JP, Fowles J, Schaffarzick R:  Evaluation of medical-technology strategies: II. Proposal for an institute for health-care evaluation . N Engl J Med 1982;;306:687-692.
12 +
Frederickson DS:  Biomedical research in the 1980s . N Engl J Med 1981;;304:509-517.
13 +
 Office of Health Economics: Scarce resources in health care . Milbank Mem Fund Q 1979;;57:265-287.
14 +
Ramsey P: The Patient as a Person: Explorations in Medical Ethics . New Haven, Conn, Yale University Press, 1970;.
15 +
Wertz RW (ed): Readings on Ethical and Social Issues in Biomedicine . Englewood Cliffs, NJ, Prentice-Hall Inc, 1973;.
16 +
Beauchamp TL, Childress J: Principles of Biomedical Ethics . New York, Oxford University Press, 1979;.
17 +
Stein J: Making Medical Choices: Who Is Responsible ? Boston, Houghton Mifflin Co, 1978;.
18 +
Callahan D:  Shattuck lecture: Contemporary biomedical ethics . N Engl J Med 1980;; 302:1228-1233.
19 +
Tancredi LR:  Social and ethical implications in technology assessment , in McNeil BJ, Cravalho EG (eds): Critical Issues in Medical Technology . Boston, Auburn House, 1982;, pp 93-112.
20 +
Evans RW, Blagg CR, Bryan FA Jr:  Implications for health care policy: A social and demographic profile of hemodialysis patients in the United States . JAMA 1981;;245:487-491.
21 +
Crane D:  Decisions to treat critically ill patients . Milbank Mem Fund Q 1975;;53:1-33.
22 +
Crane D: The Sanctity of Social Life: Physician's Treatment of Critically Ill Patients . New York, Russell Sage Foundation, 1975;.
23 +
Becker EL:  Finite resources and medical triage . Am J Med 1979;;66:549-550.
24 +
Civetta JM:  The inverse relationship between cost and survival . J Surg Res 1973;; 14:265-269.
25 +
Cullen DJ, Ferrara LC, Briggs BA, et al:  Survival, hospitalization charges and follow-up results in critically ill patients . N Engl J Med 1976;;294:982-987.
26 +
Turnbull AD, Carlton G, Baron R, et al:  The inverse relationship between cost and survival in the critically ill cancer patient . Crit Care Med 1979;;7:20-23.
27 +
Thibault GE, Mulley AG, Barnett GO, et al:  Medical intensive care: Indications, interventions, and outcomes . N Engl J Med 1980;;302:938-942.
28 +
Detsky AS, Stricker SC, Mulley AG, et al:  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit . N Engl J Med 1981;;305:667-672.
29 +
Martin SW, Donaldson MC, London CD, et al:  Inputs into coronary care during 30 years: A cost-effectiveness study . Ann Intern Med 1974;; 81:289-293.
30 +
Zook CJ, Moore FD:  High-cost users of medical care . N Engl J Med 1980;;302:996-1002.
31 +
Schroeder SA, Showstack JA, Schwartz J:  Survival of adult high-cost patients: Report of a follow-up study from nine acute-care hospitals . JAMA 1981;;245:1446-1449.
32 +
Silverman WA:  Mismatched attitudes about neonatal death . Hastings Cent Rep 1981;; 11:12-16.
33 +
Bridge P, Bridge M:  The brief life and death of Christopher Bridge . Hastings Cent Rep 1981;;11:17-19.
34 +
Cluff LF:  Chronic disease, function and quality of care . J Chronic Dis 1981;;34:299-304.
35 +
Reiser SJ: Medicine and the Reign of Technology . New York, Cambridge University Press, 1978;.
36 +
Russell LB: Technology in Hospitals: Medical Advances and Their Diffusion . Washington, DC, The Brookings Institution, 1979;.
37 +
Brown JHV: The Health Care Dilemma: Problems of Technology in Health Care Delivery . New York, Human Sciences Press, 1978;.
38 +
Ellison DL: The Bio-medical Fix . Westport, Conn, Greenwood Press Inc, 1978;.
39 +
McGinnis JM:  Recent health gains for adults . N Engl J Med 1982;;306:671-673.
40 +
Department of Health and Human Services: Health: United States, 1981 , DHHS publication (PHS) 82-1232. Hyattsville, Md, National Center for Health Statistics, 1981;.
41 +
Lerner M:  When, why, and where people die , in Brim OG Jr, Freeman HE, Levine S, et al (eds): The Dying Patient . New York, Russell Sage Foundation, 1970;, pp 5-29.
42 +
Dubos R: Man Adapting . New Haven, Conn, Yale University Press, 1965;.
43 +
Commission on Chronic Illness: Care of the Long-term Patient . Cambridge, Mass, Harvard University Press, 1956;, vol 2.
44 +
Havlik RJ, Feinleib M (eds): Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality, Bethesda, Md, October 24-25, 1978 . Bethesda, Md, National Institutes of Health, 1979;.
45 +
Dawber TR: The Framingham Study . Cambridge, Mass, Harvard University, 1980;.
46 +
Hendricks J, Hendricks CD: Aging in Mass Society: Myths and Realities . Cambridge, Mass, Winthrop Publishers Inc, 1977;.
47 +
Strauss A: Chronic Illness and the Quality of Life . St Louis, CV Mosby Co, 1975;.
48 +
Givens JD: Current Estimates From the Health Interview Survey, United States, 1978 , Vital and Health Statistics Series 10, No. 130, Dept of Health, Education, and Welfare publication (PHS) 80-1551. Hyattsville, Md, National Center for Health Statistics, 1979;.
49 +
Thomas L: The Lives of a Cell: Notes of a Biology Watcher . New York, The Viking Press Inc, 1974;.
50 +
Thomas L:  Notes of a biology-watcher: The technology of medicine . N Engl J Med 1977;; 285:1366-1368.
51 +
Banta HD, Behney CJ, Willems JS: Toward Rational Technology in Medicine . New York, Springer Publishing Co Inc, 1981;.
52 +
Ford AB:  Casualties of our time . Science 1970;;167:256-263.
53 +
Office of Technology Assessment: Assessing the Efficacy and Safety of Medical Technologies, stock 052-003-00593-0. Government Printing Office, 1978.
54 +
Larson EB:  Consequences of medical technology: Controversies and dilemmas . University of Washington Medicine 1981;;8:2-5.
55 +
Hiatt HH:  Protecting the medical commons: Who is responsible ? N Engl J Med 1975;;293:235-241.
56 +
Preston T: Coronary Artery Surgery: A Critical Review . New York, Raven Press, 1977;.
57 +
Fineberg H:  Gastric freezing: A study of diffusion of a medical innovation , in Medical Technology and the Health Care System , Committee on Technology and Health Care. Washington, DC, National Academy of Sciences, 1979;, pp 173-200.
58 +
Bunker JP, Hinkley D, McDermott W:  Surgical innovation and its evaluation . Science 1978;;200:937-941.
59 +
Banta HD, Behney CJ:  Policy formulation and technology assessment . Milbank Mem Fund Q 1981;;59:445-479.
60 +
Banta D, Sanes J:  Assessing the social impacts of medical technology . J Community Health 1978;;3:245-258.
61 +
Schwartz WB, Joskow PL:  Medical efficacy versus economic efficiency: A conflict in values . N Engl J Med 1978;;299:1462-1464.
62 +
Arnstein S, Christakis A:  Perspectives on Technology Assessment. Jerusalem , Science and Technology Publishers , 1975;.
63 +
Wagner J (ed): Medical Technology , Dept of Health, Education, and Welfare publication (PHS) 79-3254. Hyattsville, Md, National Center for Health Services Research, 1979;.
64 +
Wagner JL (ed): Medical Technology: Research Priorities . Washington, DC, Urban Institute, 1979;.
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