National Health Service

RESOURCE CONSTRAINTS AND THE QUALITY OF CARE☆

Today's western health services appear to be facing new challenges. Perhaps the most dramatic has been the re-emergence of infectious disease as a major public health problem in the developed as well as underdeveloped countries. The necessity of meeting these challenges, and at the same time demonstrating cost-effectiveness, is often considered as the prerogative of the latter quarter of the 20th century.¹ However when one traces the management of perhaps the oldest disease known to mankind, tuberculosis, one can identify that these elements have always existed. A retrospective analysis reveals how the general principals of infectious disease control evolved, and provides a model with which to approach some contemporary problems.