CHANGING HEALTH-CARE SYSTEMS

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.