Charges and Fees

James Buchanan has expressed ‘major concern’ at the escalation in the cost of care: ‘In the United States, a large and ever-increasing share of total economic value is directed toward outlay on medical or health care services … It becomes relatively easy to think of a share of one-quarter of the total value produced in the economy being devoted to medical and health care services by the century’s turn … The finitude of the resource base, the labor force and its complement of accumulated and natural capital, guarantees that the share of total value directed into medical services cannot continue to grow without limit.’1 His reference is explicitly to the United States but his anxiety is of greater generality still. In the words of an influential report submitted to the British Government in the bicentennial year of the Wealth of Nations: There is ample evidence to demonstrate that demand for health care throughout the world is rising inexorably. England has no immunity from this phenomenon. And because it can also be shown that supply of health care actually fuels further demand, it is inevitable that the supply of health care services can never keep pace with the rising demands placed upon them. Demand will always be one jump ahead. This is a problem for Government and society in general.2