Strategic choices are discussed in three main categories. One set of options reflects an extreme laissez-faire approach; it would essentially leave the problem for the health care market to sort out and eschew all but the most innocuous data collection or regulatory steps. Another takes a severe regulatory approach; it would involve the public sector or the professions, or both, in stringent steps to monitor and control the production of physicians in this country. The third set of options might be characterized generically as those belonging to a regulated or planned market; it would permit the market to work where this is perceived to be both desirable and effective and would invoke government intervention where that seemed necessary or more constructive.

As shown later, the committee en toto did not embrace the two extreme positions (all market, all regulatory), although some committee members voiced strong arguments in favor of a free market approach and others distinctly favored regulatory tactics. Rather, for pragmatic and philosophical reasons, the committee here examines several ''constrained market" steps and highlights those it believes most appealing and workable in today's environment. From this analysis, the committee reaches the five policy recommendations discussed in the remainder of the chapter.

DO NOTHING: THE FREE OR UNREGULATED MARKET APPROACH

In this strategy, little or no intervention on the part of government would be undertaken. Instead, the nation would rely on various market signals, such as underemployment of physicians, falling incomes, and similar indications to effect the appropriate corrections and to do so in a reasonably timely way. For example, such signs might discourage people from entering the medical profession at all, or they might influence specialty choice or practice location decisions.

A strong belief in the adequacy of markets in the health care arena might even dictate that the physician oversupply issue be set aside, on the grounds that imperfections in the market at the moment will, over time, correct themselves without external intervention. Backers of this view might also argue that an "oversupply" of physicians is to be welcomed because it will help a competitive, managed health care environment to function better and to hold down health care spending. It was the opinion of at least one member of the committee that a physician surplus is a precondition for the penetration of managed care into the medical marketplace and that, over the long run, managed care will have a salutary effect on the quality and costs of, and access to, medical services. In the absence of evidence to demonstrate that the current or projected surplus has had or will have significant adverse effects on any of these, the appropriate strategy,



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