Abstract The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research stated in 1983 that "Society has a moral obligation to ensure that everyone has access to adequate care without being subjected to excessive burdens."1 By this measure, the health system of the United States is failing, since millions of citizens are unable to obtain necessary care each year. This is a paradox, given the large annual medical care expenditures in the United States. In 1991, such expenditures will exceed $600 billion, or 11.5% of the gross national product, an average of $2500 per capita. Comparative health care figures reveal that the United States spends per capita 38% more money than Canada, 88% more than West Germany, and 124% more than Japan. Moreover, expenditures in the United States are rising rapidly. Between 1980 and 1987, health expenditures in the United States increased from $248 References 1. President's Commission for the Study of Ethical Problems in Medical and Biomedical and Behavioral Research. Report: The ethical implications of differences in the availability of health services. Washington, DC; March 1983;1:22. 2. Politser P, Cunico E. Socio-Economic Fact-book for Surgery 1989 . Chicago, Ill: American College of Surgeons; 1989. 3. Wennberg JE. Outcomes research, cost containment, and the fear of health care rationing . N Engl J Med . 1990;323:1202-1204.Crossref 4. Braveman P, Oliva G, Miller MG, Schaaf VM, Reiter R. Women without health insurance: links between access, poverty, ethnicity, and health . West J Med . 1988;149:708-711. 5. National Center for Health Statistics. Health, United States, 1989 . Hyattsville, Md: Public Health Service; 1990. 6. Kindig DA, Movassaghi H, Dunham NC, Zwick DI, Taylor CM. Trends in physician availability in 10 urban areas from 1963 to 1980 . Inquiry . 1987;24:136-146. 7. Gessert C, Blossom J, Sommers PS, Canfield MD, Jones C. Family physicians for underserved areas: the role of residency training . West J Med . 1989;150:226-230. 8. Morris JN. Inequalities in health: ten years and little further on . Lancet . 1990;336:491-493.Crossref 9. Bunker JP, Gomby DS, Kehrer BH. Pathways to Health: The Role of Social Factors . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1989. 10. Falk IS, Rorem CR, Ring MD. The Costs of Medical Care . Chicago, Ill: The University of Chicago Press; 1933; 592-593. 11. Education of Physicians to Improve Access to Care for the Underserved . Hyattsville, Md: Health Resources and Services Administration, US Dept of Health and Human Services; 1990. 12. Ahluwalia JS. Health care in the United States: our dynamic jigsaw puzzle . Arch Intern Med . 1990;150:256-258.Crossref 13. Kinzer DM. Universal entitlement to health care: can we get there from here? N Engl J Med . 1990;322:467-470.Crossref 14. Rockefeller JD. The Pepper Commission report on comprehensive health care . 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Am J Public Health . 1987;77:1157-1158.Crossref 23. Menken M. The changing paradigm of neurologic practice and care: implications for the undergraduate curriculum . Arch Neurol . 1990;47:334-336.Crossref 24. Schaefer M. Home and health: on solid foundations? World Health Forum . 1990;11:38-45. 25. Ellwood PM. Outcomes management: technology of patient experience . N Engl J Med . 1988;318:1549-1556. Shattuck lecture.Crossref 26. Ginsburg JA, Prout DM. Access to health care . Ann Intern Med . 1990;112:641-661.Crossref 27. Clinton JJ. From the Agency for Health Care Policy and Research . JAMA . 1990;263:2158.Crossref 28. Petersdorf RG. Medical education . JAMA . 1990;263:2652-2654.Crossref 29. Hart JT. The inverse care law . Lancet . 1971;1:405-412.Crossref 30. DeFriese GH, Ricketts TC. Primary health care in rural areas: an agenda for research . Health Serv Res . 1989;23:931-973. 31. Antonovsky A. Medical student selection at the Ben-Gurion University of the Negev . 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Archives of Neurology – American Medical Association
Published: May 1, 1991
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