Cost containment as professional challenge

Cost containment by means of prospective payment and other mechanisms is widely seen as a challenge to modern medicine; but the challenge is seldom articulated clearly in terms of core professional values and the moral content of a claim to professionalism. Medical ethics, as it has evolved as a field of study in the past twenty years, has contributed little to the concept of professionalism in medicine. For an investigation of professionalism in the face of cost containment to evolve fruitfully, several things must occur. The true nature of today's challenge to medicine must be appreciated. The balance between tradition and response to social change in defining a professional value system must be appreciated. Physician income must be explicitly addressed as a moral issue. And practical strategies for investigating and affirming core professional values must be developed for health delivery systems and medical education settings.