Will disease prevention spare the medical commons?

Everywhere the disparity grows between what modern medicine can achieve, on the one hand, and what society can afford, on the other. In industrialized nations health resource allocation questions now focus primarily on diagnostic, therapeutic and rehabilitative medical programmes. With increases both in our capabilities in preventive medicine and in public awareness of those capabilities, soon that realm is likely to be demanding more resources from the health budget. These considerations and others make urgent the development of better methods for setting priorities for the allocation of health resources. A common thread in the consideration of competing programmes will be issues of trade-offs. Beneficial programmes that save more health resources than they consume are much to be desired, but resource saving should not be regarded as a necessary condition for giving high priority to a programme. Cost-effectiveness ratios provide one approach to measuring the ability of competing programmes to use health-care resources to produce health benefits. Application of cost-effectiveness principles suggests that prevention programmes merit a greater share of resources, even though such programmes generally consume more health resources than they save. For the process of priority-setting to be equitable and rational, more and better data will be required on programmatic costs and benefits. Furthermore, the process should be flexible, allowing priorities to differ from one geographic area to another, and from time to time within the same area. Finally, the process must be understood by a majority of the population, and perceived as fair.