Resources and Systems

As the health services in developed countries continue to expand, their demands increase on skilled and expensively trained manpower. Already they employ approximately six per cent of the total manpower in some countries, ranking as the second or third largest employers. As a matter of fact, at the present rate of growth the health industry could be the biggest employer of labor well before the end of the century. On the one hand, the consumer wishes to have the latest and the best, in the way of treatment and specialties, of the technologic revolution in medicine. On the other, there has been little measurable payoff during the past three decades in terms of reduced death rates in any age group and little evidence of benefit in reduced disability; indeed, often the very advances in biomedical science simply mean that more people survive into old age, frequently on maintenance therapy and at further risk of an even more critical episode. Thus, most developed countries now proclaim a shortage of skilled manpower, some admit to having to ration resources, a few are considering a ceiling on training specialist physicians, and at least the United Kingdom is reducing the supply of acute hospital beds by one-third. In the Liverpool area, the present and related studies have contributed to such a radical redeployment of resources. This paper presents a preliminary budget of investment in the twelve study areas of the World Health Organization/International Collaborative Study of Medical Care Utilization. It gives