Bs. Bloom et Am. Fendrick, THE TENSION BETWEEN COST-CONTAINMENT AND THE UNDERUTILIZATION OF EFFECTIVE HEALTH-SERVICES, International journal of technology assessment in health care, 12(1), 1996, pp. 1-8
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.