Competition among groups for limited resources. Given demand for limited resources within the health care system and other sectors of the economy, some observers believe current services might not provide benefits commensurate with costs. However, between 80 -85% health care is still driven by the physician who may be biased toward his or her particular intervention and consented to by the patient. The high cost of care affects the relative spending for health care as compared with the environment, other personal needs such as proper nutrition and housing. Obviously, different special interest groups advocate in their own interest, and we have not seen data-driven, collaborative programmatic efforts. There are many distinctions that may give rise to competition: age groups, research vs. treatment vs. prevention; diseases; the disabled and persons with chronic illness vs. acute or high tech need. Competition is also a factor in appropriate location for care; treatment settings carry different costs and benefits to quality of care and quality of life. For example, reducing hospital insurance coverage for rehabilitation after a stroke has resulted in shift of patients to long-term care facilities not staffed or equipped to provide the same therapies.
Fuchs (1998) notes that in any one year, 5% of the population accounts for more than 50% of all health expenditures. More than one-third of all care is provided to persons over 65 years of age. Is that inequitable or simply a response to medical necessity? Intergenerational equity has become a rallying cry from several quarters including those who perceive children's needs are disadvantaged. The increasing age of the population provides several challenges to the health care system. Age is a threat to equity due to the pressures from increased costs. The increasing proportion of the elderly results in fewer younger persons to care for the aged or pay into the system.