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1、The problem of Scarce ResourcesSectionATheproblemofhowhealth-careresourcesshouldbeallocatedorapportioned,sothattheyaredistributedinboththemostjustandmostefficientway,isnotanewone.Everyhealthsysteminaneconomicallydevelopedsocietyisfacedwiththeneedtodecide(
2、eitherformallyorinformally)whatproportionofthecommunity’stotalresourcesshouldbespentonhealth-care;howresourcesaretobeapportioned;whatdiseasesanddisabilitiesandwhichformsoftreatmentaretobegivenpriority;whichmembersofthecommunityaretobegivenspecialconsidera
3、tioninrespectoftheirhealthneeds;andwhichformsoftreatmentarethemostcost-effective.SectionBWhatisnewisthat,fromthe1950sonwards,therehavebeencertaingeneralchangesinoutlookaboutthefinitudeofresourcesasawholeandofhealth-careresourcesinparticular,aswellasmoresp
4、ecificchangesregardingtheclienteleofhealth-careresourcesandthecosttothecommunityofthoseresources.在1950年之前，整个资源和Thus,inthe1950sand1960s,thereemergedawarenessinWesternsocietiesthatresourcesfortheprovisionoffossilfuelenergywerefiniteandexhaustibleandthatthec
5、apacityofnatureortheenvironmenttosustaineconomicdevelopmentandpopulationwasalsofinite.于是，在20世纪五六十年代，西方社会达成了一种共识，化石能源的供应是有限度的，同时自然和环境的承受能力也限制了经济的可持续发展。Inotherwords,webecameawareoftheobviousfactthattherewere‘limitstogrowth’.从另外一个方面说，我们已明显认识到存在“增长的限制因素”6这样一个
6、事实。Thenewconsciousnessthattherewerealsoseverelimitstohealth-careresourceswaspartofthisgeneralrevelationoftheobvious.Lookingback,itnowseemsquiteincrediblethatinthenationalhealthsystemsthatemergedinmanycountriesintheyearsimmediatelyafterthe1939-45WorldWar,i
7、twasassumedwithoutquestionthatallthebasichealthneedsofanycommunitycouldbesatisfied,atleastinprinciple;the‘invisiblehand’ofeconomicprogresswouldprovide.SectionCHowever,atexactlythesametimeasthisnewrealizationofthefinitecharacterofhealth-careresourceswassin
8、kingin,anawarenessofacontrarykindwasdevelopinginWesternsocieties:thatpeoplehaveabasicrighttohealth-careasanecessaryconditionofaproperhumanlife.Likeeducation,politicalandlegalprocessesandinstitutions,publicorder,comm
