Outcomes research, cost containment, and the fear of health care rationing.

Expectations are high for the Agency for Health Care Policy and Research, established by the 101st Congress to promote research on medical outcomes and develop guidelines for practice. Physicians and patients expect that such research will make it possible to sort out what works in medicine and learn how to make clinical decisions that reflect more truly the needs and wants of individual patients. Many business leaders, third-party payers, and policy makers believe that this effort will lead to the development of practice guidelines, which in turn will reduce the pressure for growth and produce a leaner, trimmer health care . . .