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Controlling health care costs has been a goal within the health care system for nearly 40 years. Yet, what is occurring is that health care costs are actually increasing, and the quality of care is decreasing. Patients and health professionals are complaining that accessibility to services is limited. There are inadequate numbers of nursing staff to care for patients who are both sicker and have shorter lengths of stay. Patients are bewildered by a system that they find to be extremely impersonal and difficult to navigate. This article uses a hypothetical case to identify and examine some of the ethical issues related to access to health care within a managed care system. Recommendations for nurses are presented to help them meet the challenges of limited health care resources.