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468 Annals Am. Acad. Pol. & Soc. Sci. 9 (1983)

handle is hein.cow/anamacp0468 and id is 1 raw text is: PREFACE The twentieth century has witnessed significant advances in the preservation and promotion of health. Despite these successes, numerous problems remain and new ones have emerged. Reduction in the toll of acute infectious diseases has brought more perplexing chronic illnesses to the fore. Economic growth, historically a source of improved health and well-being, is now seen as a significant cause of physical and mental illness. Advances in the preservation of health have been accompanied by substantial expansion in the size and salience of the health care sector. Total national health expenditures are now in excess of $290 billion annually, absorbing somewhat over 10 percent of the gross national product and growing at rates faster than any other sector of the stagnant economy. Partly fueled by governmental policies, this development has led to serious concern that these rapidly expanding allocations of resources are wisely regulated over various health services activities, reductions in federally and state-funded programs such as Medicaid, and the encouragement of systems of health care delivery that increase the cost-consciousness of patients by the reimposition of financial discipline. While they in some cases alter the preexisting patterns of health services, the value of these and numerous other activities is not clearly known. The increase in the health care sector is a reflection both of its scientific and technological developments and of social, political, and economic developments in society. But while vastly improving our ability to expand critical care over an increasingly large domain of illness and disability, and to bring such care to more people, high-technology medicine has raised basic societal and ethical questions regarding such large issues as equity in access to health care, quality of care, and the cost and financing of care. Embedded in these policy issues are highly technical considerations involving the structure of demand for care by various segments of the population, the factors which determine the supply of providers, the effectiveness of controls on professional practice, and the cost and outcomes of alternative institutional and organizational strategies for providing and paying for health care. These issues also entail questions about the optimal balance among equity, efficiency, and sociopolitical acceptability in social policy. In this perspective, the health care sector encompasses both personal and nonpersonal health services. Nonpersonal health services address health problems without clinical intervention, such as fluoridation of water supplies, and risk reduction. Planning for nonpersonal health services deals primarily with resource-allocation trade-offs among alter- native intervention schemes and the social and economic costs of intervention itself. The basic issues, increasingly raised, relate to the levels of acceptable risk when weighing health costs against the costs of economic disruption. The effectiveness of health care services, the efficiency with which they are produced, the Rawlsian fairness in providing access to those services, and the role 9

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