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PREFACE

How can we achieve quality health care for all
Americans at an affordable cost? This question is
being asked increasingly by business and government
leaders, health care experts, and the public.

The nation made a conscious decision many years ago to
give all Americans access to high quality care.
Programs such as Medicare and Medicaid demonstrate
this commitment. In 1984, the nation spent over $387
billion for health care, more than 10 percent of its
gross national product, or $1,580 for each person in
the United States. And the population clearly
benefited greatly from the investment in health.
In spite of these expenditures and commitment,
millions of Americans do not have access to care
because they lack adequate health insurance. In an
economy struggling with high budget deficits, the
nation may not be able to maintain the high quality,
much less expand access to its health care system,
unless the cost issue is confronted head on.

Many are questioning traditional medical practices, payment policies, and health care delivery settings, as well as how to use costly new technologies and innovations. These are but a few of the dozens of concerns clouding the health horizon that need to be addressed. Much action has been taken to constrain national health expenditures. But more will have to

be done by all sectors of our society.

The General Accounting Office has talked to more than 200 health care experts in the United States, Canada, and Europe and reviewed over a thousand pieces of literature. GAO's goal is to identify those issues that, by general agreement, need to be addressed to preserve the nation's health care system at an affordable amount. The accompanying report discusses those issues on which there was consensus.

This report should help policymakers deal with health
care cost containment issues by encouraging productive
debate on the alternatives available and areas that
need further exploration. GAO plans to analyze some
of these issues further in forthcoming reviews for the
Congress. Others in the public and private sectors
may also want to explore issues raised in this
report. The objective of maintaining a high quality
health system at an affordable cost will be furthered
by more comprehensive information and debate on how to
address these issues.

Charles A. Bowsher

Charles A. Bowsher
Comptroller General
of the United States