The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment

During the roughly four decades since the end of World War II, the health care system in the United States has experienced historically unprecedented change in three dimensions. First, new technologies have revolutionized the ways in which health care is capable of being practiced. Almost all of today's armamentarium of disease diagnosis and treatment devices and techniques were unknown 40 years ago. In the case of prescription drugs, for example, about 10 percent of the 200 largest-selling drugs are new each year; and only 25 percent of the 200 top-selling drugs in 1972 remained in the group 15 years later (David Cleeton, Valy Goepfrich, and Burton Weisbrod 1990).

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