Resource allocation in health care: the allocation of lifestyles to providers.

The objective of this article has been to draw the spotlight onto a much neglected facet of the discussion on resource allocation in health care: the process by which society decides what lifestyle the providers of health care may extract, directly or indirectly, from the patient's pocket book. Given the slice of the GNP society surrenders to the providers of health care collectively, the quantity of real health care resources made available to patients obviously varies inversely with the elevation of the lifestyle attained by the providers. These reflections have been triggered by a vexing paradox plaguing contemporary American health care: incessant talk about rationing in the midst of plenty. Conference after conference in this country has been dedicated in recent years to the "agonizing choices visited upon American health care by the age of restricting resources." Remarkably, few of the avid conference organizers, and few of their fiery orators, ever stop to think just what resource flow has actually been constricting. Has it been the supply of physicians? Has it been the supply of hospital beds? Has it been the flow of real purchasing power into the health care system? In general, the preference has been to bypass these questions altogether and to lament in a data-free context. What has been contracting in American health care has not been the flow of money into the sector, nor the flow of professionals, facilities, and entrepreneurs seeking to to do well there by doing good, but, if anything at all, the flow of real health services from providers to patients, certainly to patients who are uninsured and of modest means. And what seems required to solve the sector's problem is not so much an infusion of yet larger sums of money, but a decision-making algorithm capable of using the money already in the system to redirect real health care resources from persons who now receive perilously too many health services to persons who now receive perilously too few. Part of such an algorithm, of course, would be a sensible determination of the lifestyles the health care process needs to support among the providers of care. Under the ideal circumstances envisaged by libertarian thinkers, the determination of these matters could safely be entrusted to the free market. For reasons not difficult to fathom, however, no modern society is willing to adopt that form of arbitration over resource allocation in health care.(ABSTRACT TRUNCATED AT 400 WORDS)