A brief review of the last decade or so of developments in health politics, policy and law suggests that health is no longer a field of mere “dynamics without change.” Responding not only to economic strains but also to new conceptual challenges to the assumptions of the traditional medical model, in the 1970s and 1980s policy makers have launched various competitive and regulatory programs aimed mainly at containing costs. These interventions, however, have mainly sought savings through reductions in waste and inappropriate utilization; they have done little about deeper cost-increasing forces such as demographic trends, technology, and personnel patterns. Nor have these innovations on the cost side of the policy ledger been matched by action on the benefit side. Such changes await reconceptualization of the practical meaning of social justice and of the role of government in the health field.

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