Cost containment and the quality of medical care: rationing strategies in an era of constrained resources.

The general public, physicians, and policy makers have all come to accept constraints on public expenditures for medical care as a reasonable means to redirect resources to competing sectors of national life, and to reflect changing political and social values. "Rationing" of facilities and services by explicit and implicit methods seems inevitable; the poor and disabled must not bear the brunt of stringency. The politics of competition and altered power relationships among providers offer new opportunities for system-wide reform.