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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.
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