Effectiveness

Health care is health care. Health status is health status. The input is the input. The outcome is the outcome. The precise relationship between the means and the end is the ultimate explicandum in the continuing debate about health policy. It is an explicandum that remains strikingly under-explained: ‘Most common medical procedures’, Henry Aaron observes, ‘have never been subject to controlled evaluation to determine in which case the procedures produce expected benefits and whether alternative approaches might be superior. Some analysts hold that simply by eliminating care that produces little or no benefit, health care expenditures could be cut as much as 30 per cent and that service could be extended and improved at no increase in cost.’1 If only the medical production-function were to be properly specified, then unnecessary tests and spurious treatments could be eliminated in order that maximum health might successfully be delivered by a given budget. Yet too little is known about the actual linkage between health care resources and health status indicators. The result is bound to be a slippage and a waste that is especially deplorable in the light of the pain and the danger that medical care so frequently brings with it.