Effectiveness and efficiency under competition: the Cochrane test.
1991; BMJ; Volume: 303; Issue: 6812 Linguagem: Inglês
10.1136/bmj.303.6812.1253
ISSN0959-8138
Autores Tópico(s)Merger and Competition Analysis
ResumoA major purpose of introducing economic competition into health services in Great Britain, Holland, Germany, and elsewhere is to increase efficiency and cost effectiveness.Paradoxically, competitive markets may actually reduce efficiency because provider-sellers dominate the market' and may respond in ways that decrease efficiency2 and because many inefficiencies are embedded in "the way things are done."3There are more direct routes to efficiency and cost effectiveness that avoid the distortions and added costs of markets.Several insights can be gleaned by revisiting Archie Cochrane's classic work, Effectiveness and Efficiency.4Cochrane's message is the primacy of effectiveness for attaining efficiency.The current focus on mana- gerial efficiency in the NHS would seem to him misdirected.How, he might ask, can one increase efficiency through competitive contracts if the contractors do not know what is effective?Cochrane is more clearheaded than almost anyone concerned with outcomes (effectiveness) and efficiency in professional circles today.How many outcome studies can pass what might be called the Cochrane test?
Referência(s)