Chapter 6: Efficiency
The primary condition is that the job must get done. A health care system cannot be judged by its good intentions or by the sheer numbers of its inputs. The only test can be that of success. The means must deliver the ends. They must do so with the minimum amount of slippage. Underachievement means that scarce resources fall through the cracks. It is not a luxury that any health care system in the world can afford. The means–ends relationship has four dimensions. First, there is medical effectiveness: the treatment must be the best way of securing the desired outcome. Second, there is economic effectiveness: a given endstate must be secured with the lowest commitment of social resources. Third, there is cost-benefit: not only must the roads to a single destination be ranked by cost, the next-best targets must also be compared and assessed. Fourth, there is cost-utility: the members of the community must be able to secure the maximum amount of felt satisfaction from a given health care allocation. The first three dimensions will be examined in the three sections of the present chapter. Utility is the subject of chapter 7. Different procedures entail different costs. Given the resources constraint, health care must be budgeted with a view to miles per gallon as well as the humanitarian objective of saving lives which a prudent use of the scarce endowment is itself likely to advance. No one would say that a parent should cost-benefit the resuscitation of a child...
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