Confronted with deep—seated problems of spiralling health care costs, the United States is actively considering rationalization as a means for improving efficiency and effectiveness in the operation of health services. The application of managerial and organizational principles characteristic of large—scale business and industry, i.e. quantification of decision—making, consolidation of production, money rewards for cost savings, and economies of scale, is increasingly seen as the key to successful control of the health economy. The drive for rationalization is assessed in terms of its probable impact on the following issues: (a) the scope of health—field boundaries and program responsibilities; (b) the influence of health professionals in policy and planning; (c) the role of altruistic ideals as compared to market values in conditioning provider behavior; and (d) the relationship of health services to larger social and philosophic aims. Because of the tendency toward convergence in the problems governments face in the financing and delivery of health care, it is suggested that developments in the United States may be relevant to other countries in similarly advanced stages of economic growth.
Mental health services in Nicaragua: Ten years of revolution