Rationing of medical care and the preservation of clinical judgment

It is inevitable that efforts to contain medical care costs will increase. Approaches to cost containment vary substantially and have different effects on access, equity, and professional performance. Cost sharing primarily affects the behavior of patients, while other types of regulation are intended to influence how physicians practice. While some types of physician regulation such as prospective budgeting are intended to constrain physician decision making without dictating clinical judgment, other approaches are more intrusive on physician autonomy. Physicians should contribute to the development of regulatory approaches consistent with the responsible exercise of clinical judgment and professional autonomy.