Managed care and health care rationing

Health care in the 1990s has been characterized as 'better services to fewer people at higher cost.' The current effort to balance high-quality care with cost efficiency has presented a challenge unlike any other in our history. In this article we have described innovative approaches-managed care and health care rationing-that have pushed the limits of our thinking about health care delivery. Both ideas are unsettling to many in our society. They represent the first meaningful efforts to address core problems in our previously thoughtless healthcare evolution. These approaches emphasize cost effectiveness and social values in a carefully budgeted process. The Oregon Health Plan represents one method for consciously seeking a rational blending of societal demands for universal access to health care, accountability for decision making, and a sensitivity to fiscal limits. The discussion of this program will no doubt stimulate the development of other new and innovative proposals in the future.