some readers may object that the price paid by patients need not increase in countries where the government guarantees free care. However, as we have seen, even with HIV prevalence rates of 5 percent or less, the demand for medical care is likely to increase faster than the government’s ability to supply it. When this happens, means of rationing medical care other than price come into play. People in countries where health care is officially "free" are familiar with these mechanisms. Some systems rely on waiting time. In others, a patient dissatisfied with inferior care in a public facility can pay for better care during a doctor’s private office hours. In still other cases, side payments to a nurse or other gatekeeper are necessary in order to get access to "free" care. The effective price of health care to the consumer is the value of all of the consumer’s sacrifices, in time and in money, needed to obtain care of a given quality. The AIDS epidemic increases the effective price, even if care is supposedly "free."
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