1. Introduction
There is growing interest, in Australia as elsewhere, in the concept of health
outcomes and in re-orienting the health care system to focus on health gain.
The National Health Strategy has reported that "it is important to shift the
emphasis from funding and providing health services and institutions to
providing care that improves health" (National Health Strategy 1992, p. 15).
The NSW Health Department has embarked upon a Health Outcomes Program
"to re-orient the planning, implementation and evaluation of health and related
services" (NSW Department of Health, 1993, p. 2). Health outcomes have been
included in the new Medicare (Commonwealth-State financing) agreements
(Roy Harvey, personal communication). Whilst there is little disagreement that
health outcomes are "the way to go", there is still a lack of clarity and indeed
some confusion about what health outcomes actually are.
There appear to be two concerns that are driving this interest in outcomes;
efficiency and accountability. Australia, like most other OECD countries, has
succeeded in controlling the overall increase in health care expenditures but
there is still concern that what is being spent is not being used efficiently or to
maximum effectiveness (Hurst 1991, Altman and Jackson 1991). Pressures on
the health care budget will continue with changing demographic patterns,
epidemiology and advances in health care technology. At the same time, health
care policy makers, administrators. and clinicians at all levels are required to
become more accountable. Health services are required to be more responsive to
community and consumer preferences at a time when community expectations
are being raised.
In health care now, doing good is no longer good enough; we need to do better.
Hence the drive towards health outcomes; health outcomes are about doing
better.
Economics is also about doing better, by making objectives explicit and by