Equity, Efficiency, and Effectiveness in Healthcare

Healthcare providers are increasingly under pressure to prove that their services are being delivered in an efficient and effective manner. Those [Page 373]funding healthcare services—both third-party payers and consumers—are demanding more accountability. And policymakers are seeking measures that are objective and based on empirical evidence.

The reason for this pressure for greater accountability is that policymakers recognize that healthcare providers have an obligation to demonstrate that what they are doing is having some specific effect. In other words, it is possible to document outcomes from particular service delivery models or programs.

With rising healthcare costs squeezing profits and the growing numbers of people without health insurance pushing costs even higher, many employers are beginning to highlight healthcare costs and benefits as one of the most important issues to be addressed. At the same time, employees faced with increased cost sharing, the increased cost of health insurance, and the growing numbers of people without any kind of insurance are also pointing to healthcare as a “crisis.”

Healthcare policymakers are concerned with whether it is possible to develop measures to document improvement or change for particular medical conditions. They raise a number of questions. For example, what should be the standard for assessing whether a consumer/patient has gotten better or worse as a result of a given treatment or service delivery model? What specific outcome or set of outcomes is a treatment aimed at? It should be noted that the state of the art in terms of measuring medical outcomes is not such that one can be particularly precise about the results that have been achieved. How does one, for example, compare four units of wellness with two or three units? Can an outcome such as wellness really be measured at interval levels where one assumes that each additional unit of wellness has the same value as another unit?

More specifically, healthcare policymakers at the national, state, and local levels have demonstrated an increasing concern for equity, efficiency, and effectiveness of healthcare.