The Author States That "When Need Is the Allocative Principle

The author states that "When need is the allocative principle at work, the pressure to ration non-urgent care, particularly surgical interventions, becomes more intense." What does she trace this back to?

A) the change in federal government funding from reimbursement to global budgets
B) the tendency of medical students to opt for specialties over primary care
C) the lack of physicians willing to practice in less densely populated or more remote areas
D) the shift from not-for-profit to for-profit hospitals