FOR GOODNESS SAKE - EXPECTED THERAPEUTIC BENEFIT AS A BASIS FOR HEALTH-CARE-DELIVERY

The current debate on our healthcare system has focused primarily on t he cost of care. Because of drastically rising costs and their burden on our economy, government and the private sector have developed many approaches to reduce these costs. Managed care, special contracting ar rangements, and government fiat have all been used to stem the tide of rising costs-with variable success. We propose that the primary goal of healthcare is the provision of patient benefit, and we describe a m odel that calculates an expected benefit in terms of survival and qual ity of life. We have applied this model to a cohort of patients underg oing coronary angiography to determine the distributions of benefit. F urthermore, we describe a reimbursement strategy that relates the expe cted therapeutic benefit to the reimbursement received for that therap y-the greater the benefit, the greater the reimbursement. The future o f our healthcare system lies in keeping the patient at the center of t he debate on the delicate balance between optimal care and societal co st.