title: Health, medicine, and ophthalmology: facing the facts and paying the piper LVI Edward Jackson Memorial Lecture.
abstract: OBJECTIVE
  To describe the sources of tension within the health care system and methods for pursuing their solution.
  
  
  METHODS
  Presentation of observations pertinent to patient, provider, and payer perspectives relevant to the cost, delivery, and quality of care and their impact on health.
  
  
  RESULTS
  Societal forces, not just wealth, are major determinants of both health and the costs of health care.
  
  
  CONCLUSIONS
  Tensions created by rising health care costs in the face of finite societal resources will increase in the years ahead. These can be resolved only by realizing new efficiencies in care, and prioritizing, through an explicit process, the care that is to be provided.
authors.affiliation: School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205-2179, USA. asommer@jhsph.edu
authors.forename: A
authors.initials: A
authors.lastname: Sommer
mesh_terms: D003363:Cost Control; D003695:Delivery of Health Care / Q000191:economics* / Q000639:trends; D006262:Health; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics* / Q000639:trends; D006801:Humans; D009885:Ophthalmology / Q000191:economics* / Q000639:trends; D010361:Patients; D011445:Prospective Payment System / Q000191:economics* / Q000639:trends; D014481:United States