Health care economics is primarily concerned with the study of scarcity and choice. This has become increasingly important as health care spending is reduced. Reductions in spending are driven by federal and provincial government deficit reduction. Health economics analysis can be applied from a number of perspectives. Many physicians perceive health economics as a cost cutting exercise not primarily concerned with the quality of patient care. Health economics analysis may lead to ethical dilemmas in the physician/patient relationship. The physician's obligation to maintain an ethical relationship with patients may conflict with his or her role as rationer of health resources. It is difficult to balance conflicting roles, but physicians are obliged to participate in the economic debate to ensure optimal patient care.