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A central health policy issue is whether the nation will accept and act on the premise that it must ration effective medical services. Rationing is any set of activities that determines who gets needed medical care when resources are insufficient to provide for all. Perhaps one-third of the financial resources devoted to health care today is being spent on ineffective or unproductive care. The authors conclude that development of an equitable and responsive health system need not entail rationing effective services. Reaching this goal requires, among other things, greater public accountability by physicians for their performance and greater cooperation by the public in making available the information needed to support performance-based review.

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