Buttonwood on coverage, cost, choice of public services

From the June 23 Buttonwood column in the Economist:

POLICYMAKERS must juggle three priorities when offering a public service: coverage, cost and choice. They almost always have to sacrifice at least one of the three. As austerity bites, this equation is going to lead to very tricky decisions.

Health is an area where the trilemma clearly applies. Britain’s National Health Service offers universal coverage but as a result has to limit patient choice in order to control the costs. The American health system historically gave a high priority to patient choice at the price of ballooning costs and the exclusion of the uninsured from the system. Having increased coverage, the Obama reforms will have to restrict choice if they are to control costs.

There is certainly a relationship between coverage, cost and choice in health care, but there is something equally important missing from this formulation: the outcome or effectiveness of care. It is impossible to tell how important limits in the types of care patients may choose without knowing the relative effectiveness of the care in question. Determining how to systematically provide information on whether a given care option improves quality of life and/or extends life is a top priority. Only then can you evaluate the value of coverage, cost and choice and make the hard decisions described in the Economist in a meaningful way.


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