Many governments are encouraging competition for resources between hea
lth centres in an attempt to reduce costs and improve the quality of s
ervices. However, opponents to managed care believe that this will cre
ate more administrative costs and reduce patient choice. So-called pur
chasing organizations are being established to direct patients to the
most cost-effective care. Assessing performance is complicated as very
sick or difficult-to-treat patients are likely to be more costly. Sta
tistical techniques can be used to clarify the impact of risk factors,
such as smoking, on the outcome of care.