Health care is one of the most important and complex issues affecting society today. Individuals want to receive services that will allow them to maximize their health potential, meet their personal goals, and protect their mental and physical well being. Health care professionals, administrators, and others seek to provide these services in an efficient manner with appropriate resources. But the increasing integration of financing and delivery of health care services, a strong trend toward for-profit enterprise in the health care industry, and the growth of managed care have created many challenges. These challenges can affect the quality of health care.
Health care resource allocation questions can be viewed at the level of the whole system of healthcare or at the level of the individual institutions and practices that comprise a system. At the macroallocation level, the broad question is what priority should be given to healthcare compared to other areas competing for government funding, laws, and policies, such as defense, education, and commerce. At the microallocation level, the question is what should be allocated among the individual institutions or to individual patients within a system, for example which hospitals and which physician groups should be part of a particular system.
A key issue in allocating healthcare resources is the extent to which people believe that the quality of medical services should be dependent upon available resources. Some, for instance, argue that healthcare should be a public good because the effects of illness, disease, and injury on individuals are widely felt throughout the community. They view health care as a type of infrastructure that provides a social service, similar to highways and public schools.
Others, however, think that health care is different from other goods and services because the quality of healthcare has an immediate impact on people’s lives. In addition, many people believe that the nature of health problems and the effects of healthcare are so mysterious and awesome that the quality of care should be based on values and feelings that are not easily quantified (President’s Commission, 1983).
Various approaches to allocation of healthcare resources have been used in the United States. Some are more centralized and centrally controlled, while others emphasize the importance of market forces and private ownership. Despite the many different approaches, there is general agreement that it is critical to have meaningful information and communication between consumers and providers of healthcare. Such a system would allow all parties to balance their own perspectives, concerns, and priorities and to make decisions that reflect the collective interest in a high-quality healthcare system. A focus on decision making also addresses the thorny elements of professionalism, regulation, competition, and malpractice that are associated with efforts to define quality in healthcare. This approach can be a unifying force in a world that is filled with a variety of conflicting opinions and interests. Several important issues still remain, though. The definition of quality in healthcare needs to be further developed, and some concerns have been raised about the need for more research on issues such as cost-effectiveness.