THE TENSION BETWEEN COST-CONTAINMENT AND THE UNDERUTILIZATION OF EFFECTIVE HEALTH-SERVICES

One of the common ingredients in all attempts to slow escalating healt h care costs is to control the utilization of services that provide li ttle or uncertain benefit. To reform existing delivery systems, the or ganization, provision, and financing of health care need to be evaluat ed critically. Successful reform requires that more rational methods b e used to determine which services to provide. The preferences of phys icians, patients, and payers of care do not appear optimal from a soci etal perspective in choosing health care services. While reducing the use of interventions of little or unknown benefit should save money, a policy to restrict the use of medical services may lead to an unwante d result: the underutilization of interventions of proven clinical ben efit. Through the determination of the value-by rigorous assessment of both costs and benefits of available alternatives - in a context sens itive to the unique cultural, political, and economic characteristics of individual nations, the health of the population should be improved and growth of health expend itu res constrained. This is the fi rst s tep in health care reform.