Allocation of medical resources: problems faced by the practicing neurosurgeon.

The allocation of medical resources by the neurosurgeon begins with the patient-physician relationship and is increasingly affected by managers of third-party payers, the desire for patient autonomy, quality assurance regulation, state regulatory requirements, and the present recriminatory legal system. In addition, fiscal constraints within institutions impact on decisions regarding the allocation of medical resources by the physician. Beyond these micro-allocation problems lie the macro-allocation difficulties at the levels of state and federal government, where concepts of equality and justice--as they relate to allocation of resources--are altered by political forces; aging populations; new, devastating diseases; availability of rapidly improving technical, diagnostic, and treatment modalities; and the attendant costs and related tax burdens on the populace.