Regionalization, prioritization, and sailing ships in the year 2010

In the past, healthcare providers have been allowed to create demand for medical services, then supply that demand in an open market. The reimbursement industry responded by denial of payment on the basis of retrospective audit. Yet, are continue to provide services with no assurance that any service will be funded, a self-fulfilling prophecy of doom. If we are to survive to see 2010, we must learn how to conserve and prioritize the use of increasingly scarce resources. As a political process, it is essential to match resources to need by regionalization at both the macro- and microallocation levels. There are powerful and well-financed forces that would slice up the pie for the benefit of those with the sharpest knife. If we expect the ship to stay afloat, we must become personally involved in bailing out the bilge. Our future outcome as advocated of good patient care is directly dependent on learning to play the political game better than we do now.