Managing finite resources

Bruce P. Squires, MD, PhD
Editor-in-chief

Canadian Medical Association Journal 1996; 154: 1139

In this issue (see pages 1161 to 1168) Drs. Jeremiah Hurley and Robert Card allude to Garrett Hardin's much-cited article "The tragedy of the commons" (Science 1968; 162: 1243-1248) in explaining the conflict that inevitably arises when a resource becomes limited. On the one hand, physicians have a personal interest in maintaining their own incomes; on the other hand, they have a collective interest in limiting the total billings of all physicians to avoid the hated clawbacks, holdbacks or paybacks to which all are subject when total billings exceed the amount allocated by government. Hurley and Card go on to describe several principles for the successful management of limited resources in the face of such conflicting incentives. This is a welcome change from the argument that all we need to do is provide more resources for medicine, or permit privatization so that those who can afford it can gain access to the re- sources they want.

The issues of limited resources and the conflict between individual self-interest and the need to ensure equitable access to those resources are not, of course, confined to physicians' billings and medical care. Indeed, Hardin pointed out in 1968 that population growth was rapidly exceeding the carrying capacity of the world -- the commons -- and that we could no longer retain the freedom to breed.

The world's resources are finite and diminishing rapidly, yet we in developed countries continue to consume them at a much greater rate than do those in less developed countries; we also continue to cherish the mistaken belief that bringing the rest of the world "up" to our level of education, economic prosperity and health will solve the global problems of starvation, disease and conflict.

The principles that Hurley and Card suggest are appropriate to managing the limited resources available to physicians in Canada and may be fundamental to stopping or, at least, slowing the rapid exhaustion of our planet's resources.

| CMAJ April 15, 1996 (vol 154, no 8) |