ABSTRACT
Public debate over the cost and quality of, and access to health care in the United States has increased in volume and intensity over the last several years as society grapples with the question of how to allocate limited health resources. Rising health costs in the past two decades have ushered in policies to contain costs. Every method of allocation must confront the question of how to define and ensure access to essential services. Existing mechanisms allocate health resources on the basis of economic or administrative constraints. As such, it is our contention that neither of the existing mechanisms—namely cost sharing and prepayment—alone is sufficient to resolve the "tragic choice" confronting US society. Medicine has become sufficiently vast and complicated, technology changes sufficiently fast, and the magnitude of public resources expended sufficiently large, to warrant the explication of guidelines and the implementation of a system of voluntary audits and incentives.
