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Abstract

Efficiency has become of central importance in health care and is seen as wholly laudable. It appears to offer a precise and objective means of evaluating and comparing institutions, practices and individuals, and is a principle that underlies techniques of cost-benefit analysis and other methods of option appraisal. However, there is a need to examine the concept of efficiency and explore the problems of its application within health care. Efficiency is a value laden notion and it cannot be used as a means of making value judgements from purely factual premises. We have to choose the inputs and outputs in our calculations, and what limits to set on their scope. Efficiency calculations may require us to measure what cannot be quantified, and to treat as commensurable what is incommensurable. There are circumstances in which considerations of efficiency are inappropriate or even immoral.

Keywords

efficiency health care health economics value judgements

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References

McGuire A , Henderson J , Mooney G. The economics of health care: an introductory text. London: Routledge , 1988.

Mooney G. Key issues in health economics. Hemel Hempstead: Harvester Wheatsheaf , 1994.

Mooney G , McGuire A eds. Medical ethics and economics in health care. Oxford: Oxford University Press , 1988.

Williams A. The value of QALYs . Health Soc Serv J 1985; 3 (18 July).

Williams A. Economics of coronary artery bypass grafting . Br Med J 1985; 291: 326-329 .

Gudex C , Kind P. QALY toolkit. University of York: Centre for Health Economics , 1987.

Kind P , Rosser R , Williams A. Valuation of quality of life: some psychometric evidence. In: Jones-Lee MW ed. The value of life and safety. Amsterdam: Elsevier/North-Holland , 1982.

Leibniz GW. Monadology and other philosophical essays. (First published 1666.) Translated by Schrecker P and Schrecker AM. Indianapolis: Bobbs-Merrill , 1965.

Bentham J. The principles of morals and legislation. (First published 1789.)

10.

Scheffler S ed. Consequentialism and its critics. Oxford: Oxford University Press , 1988.

11.

Smart JJC , Williams B. Utilitarianism: for and against. Cambridge: Cambridge University Press , 1973.

12.

Dickenson D. Is efficiency ethical? Resource issues in health care. In: Almond B ed. Introducing applied ethics. Oxford: Blackwell , 1995: 229-246.

13.

Maclean A. The elimination of morality: reflections on utilitarianism and bioethics. London: Routledge , 1993.

14.

Hume D. A Treatise of Human Nature. (First published 1739.) Edited by Selby-Bigge LA and revised by Nidditch PH. Oxford: Oxford University Press , 1978.

15.

Hudson WD ed. The is/ought question. London: Macmillan , 1969.

16.

Hudson WD. Modern moral philosophy. London: Macmillan , 1970.

17.

Pigden CR. Naturalism. In: Singer P ed. A companion to ethics. Oxford: Blackwell , 1993: 421-431.

18.

Haydock A.

QALYs - a threat to our quality of life?

J Appl Philos 1992; 9: 183-188 .

19.

Harris J. QALYfying the value of life . J Med Ethics 1987; 13: 117-123 .

20.

Rawles J. Castigating QALYs . J Med Ethics 1989; 11: 143-147 .

21.

Lockwood M. Quality of life and resource allocation. In: Bell JM , Mendus S eds. Philosophy and medical welfare. Cambridge: Cambridge University Press , 1988: 33-55.

22.

Hutton JL. Statistics is essential for professional ethics . J Appl Philos 1995; 12: 253-261 .

Efficiency and Health

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