Over the past decades, health care delivery - once characterized by clearly defined relationships between medical professionals, regulators, and industr- has become much more complex. Traditional roles and relationships are changing and new decision-makers are entering the scene. They bring into the discussion the need for cost containment and the changing perceptions of the public with regard to the risks and benefits of health care outcomes. As benefits of medical care are increasingly questioned and as scepticism and fear of advanced technologies are demonstrated by a growing body of people, decision making must move beyond medical concerns to encompass economic, political, and sociological considera tions. This evolution has also affected the pharmaceutical industry. Public percep tion of responsibility for product safety is no longer limited to regulators and physi cians. Manufacturers, previously unencumbered by social policies, governmental preoccupations, or public expectations, are now held accountable for product safety. As a certain amount of risk acceptance is, however, a prerequisite for the further development of health care goods, it has to be carefully balanced against society'S demand for safety. To weigh risks against benefits, to define acceptable risk, and to exclude what no longer falls within this category remain perpetual challenges. Accordingly, health care outcomes have to be assessed not only from a clinical point of view, but also from an economic and societal perspective. The assessment of drug risks and benefits has become an important political issue world-wide.

All too frequently, the largest effective barrier to interdisciplinary communication is jargon. The symposium whose proceedings appear in the following pages sought, of course, to eliminate unnecessary and obscurantist jargon; but it sought also to do something far more ambitious - to confront the intellectual issues that are attached to the use of the word "evaluation" in medicine and health services. To this end a carefully selected group of experts in medicine, epidemiology, and health econom ics was invited to present papers. They were selected for their reputations either as conceptualizers or as empirical evaluators, or - the rarest breed of expert - as both. The context was to be empirical. Three procedures were selected that had been subject to evaluation but that posed rather different types of problem. The first was the treatment of renal failure by dialysis of various kinds. This has a relatively long history of evaluation, with a large literature, and particularly raises broad policy is sues within the health services of Western societies as to - the size of programmes to be provided; the type, location, and mix of treatments; the selection of patients to receive treatment; and the measurement of the success of various strategies. The second was the treatment of duodenal ulcer by a new species of drug - the hista mine Hrreceptor antagonists (specifically, cimetidine)."

The "Encyclopedia of Health Economics" offers students, researchers and policymakers objective and detailed empirical analysis and clear reviews of current theories and polices. It helps practitioners such as health care managers and planners by providing accessible overviews into the broad field of health economics, including the economics of designing health service finance and delivery and the economics of public and population health. This encyclopedia provides an organized overview of this diverse field, providing one trusted source for up-to-date research and analysis of this highly charged and fast-moving subject area.
Features research-driven articles that are objective, better-crafted, and more detailed than is currently available in journals and handbooksCombines insights and scholarship across the breadth of health economics, where theory and empirical work increasingly come from non-economistsProvides overviews of key policies, theories and programs in easy-to-understand language

The Handbook of Health Economics provide an up-to-date survey of the burgeoning literature in health economics. As a relatively recent subdiscipline of economics, health economics has been remarkably successful. It has made or stimulated numerous contributions to various areas of the main discipline: the theory of human capital; the economics of insurance; principal-agent theory; asymmetric information; econometrics; the theory of incomplete markets; and the foundations of welfare economics, among others. Perhaps it has had an even greater effect outside the field of economics, introducing terms such as opportunity cost, elasticity, the margin, and the production function into medical parlance. Indeed, health economists are likely to be as heavily cited in the clinical as in the economics literature. Partly because of the large share of public resources that health care commands in almost every developed country, health policy is often a contentious and visible issue; elections have sometimes turned on issues of health policy. Showing the versatility of economic theory, health economics and health economists have usually been part of policy debates, despite the vast differences in medical care institutions across countries. The publication of the first Handbook of Health Economics marks another step in the evolution of health economics.

As a relatively new subdiscipline of economics, health economics has made many contributions to areas of the main discipline, such as insurance economics. This volume provides a survey of the burgeoning literature on the subject of health economics.

Das groBte Hindernis, das dem interdisziplinaren Gedankenaustausch im Wege steht, ist haufig der Jargon. Wahrend des Symposiums, des sen Beitrage und Diskus- sionen auf den folgenden Seiten verOffentlicht werden, versuchten wir natiirlich, jede unnotig verschleiernde Fachsprache auszuschalten; gleichzeitig waren wir be- strebt, ein vie! ehrgeizigeres Ziel zu erreichen: die Konfrontation mit den intellektu- ellen Sachverhalten, die mit der Verwendung des Wortes "Evaluation" in der Medi- zin und den Gesundheitsdiensten verbunden sind. Zu diesem Zweck wurde eine sorgfaltig ausgewahlte Gruppe von Experten aus den Gebieten der Medizin, der Epidemiologie und der Gesundheitsokonomie einge!aden, zum selben Thema Vor- trage zu halten. Sie wurden entweder aufgrund ihres Rufs als "Synthetiker" oder als empirische "Analytiker" oder - die seltenste Expertengruppe - als beides in einer Person gebeten, ihren Beitrag zu leisten. Urn den Praxisbezug zu gewahrleisten wurden 3 Verfahren ausgewahlt, fUr die bereits Evaluationen voriagen, von denen jedoch jedes besondere Probleme auf- warf. 1m ersten Fall handelte es sich urn die Behandlung des Nierenversagens durch verschiedene Dialyseverfahren. Die Evaluation dieser Therapiemethoden reicht verhaltnismaBig weit zurUck, und die entsprechende Literatur ist umfang- reich. Insbesondere stellen sich aber weitreichende konzeptuelle Fragen fUr die Ge- sundheitsdienste der Industriegesellschaften sowohl in bezug auf den Umfang der bereitzustellenden Programme, die Art und die Kombination der Behandlungen als auch beziiglich der Auswahl der zu behandelnden Patienten. Die Messung des Er- folgs der diversen Strategien verursacht okonomische und medizinisch-soziale Pro- bleme besonderer Art.