Since the end of World War II, the provision of medical care
in the United States and other advanced countries has displayed three major
features: first, rapid advances in the science of medicine; second, large
increases in spending, both in terms of inflation-adjusted dollars per person
and the fraction of national income spent on medical care; and third, rising
dissatisfaction with the delivery of medical care, on the part of both
consumers of medical care and physicians and other suppliers of medical care.
Rapid technological advances have occurred repeatedly since
the Industrial Revolution—in agriculture, steam engines, railroads, telephones,
electricity, automobiles, radio, television, and, most recently, computers and
telecommunication. The other two features seem unique to medicine. It is true
that spending initially increased after non medical technical advances, but the
fraction of national income spent did not increase dramatically after the
initial phase of widespread acceptance.
On the contrary, technological
development lowered cost, so that the fraction of national income spent on
food, transportation, communication, and much more has gone down, releasing
resources to produce new products or services. Similarly, there seems no
counterpart in these other areas to the rising dissatisfaction with the
delivery of medical care.
