Medicine is news. There is constant public interest in health and
disease; in medical miracles and in breakthroughs; in medical disasters,
failures and malpraxis; in deficiencies and defects ofhealth services;
and in the rising costs ofhealth care. Medicine is 'big business'.
Physicians co me out near the top money earners in most medical care
systems. In the Uni ted Kingdom the National Health Service (NHS) now
costs over [6000 million a year ($ ro 800 million), a free service that
costs every British man, woman and child [120 a year ($216) in direct
and indirect taxes. But this is less than the [500 ($900) a year that
medical care costs each person in USA and West Germany. In developed
countries health care costs are approaching ro% ofthe gross national
product (GNP). It is big business also in that in Britain the NHS is one
of the largest employers; about I million Britons work as employees of
the NHS, caring for the other 54 millions and in the USA the numbers are
5 million caring for 2. 5 millions. The provision of health services is
full of problems and dilemmas. These problems and dilemmas cross all'
national boundaries. All countries share the same problems and dilemmas.
Problems of objectives, of standards, of effectiveness and efficiency,
and problems of relations between the medical profession, the public and
govern- ment. Medical care still is full of mystique.
