Controlling Costs: Strategic Issues in Health Care Management

Controlling costs in health care is rarely something that can be tackled in isolation. Cost control invariably interacts with issues of quality and health care access. Thus, this diverse collection of papers is concerned not just with costs but more importantly with value. Both macro and micro concerns are covered. At the macro level, health care reforms (and especially the 'marketisation' of health care systems) receive some attention. Papers explore how policy prescriptions get translated and modified during implementation, and assess how these prescriptions impact on both the incentive context and subsequent patterns of service delivery. Resource allocation within bureaucratic health systems continues to pose problems and these too are analysed with new solutions being proposed. At the micro level, a number of contributors wrestle with the difficulties of carrying out the economic evaluation of new drugs and technologies. In each case, the wider theoretical and practical implications of balancing costs and benefits are explored. This collection should prove helpful to health care policy specialists, managers and researchers interested in gaining a feel for the real-world application of cost-focused health services research.

Huw T.O. Davies, Manouche Tavakoli

Contents: Controlling Costs In a Changing World: Regulating health care markets, Alan Maynard; The need for change: health reforms in Turkey, Nesrin E. Ã+ilingiroglu; Changing patterns of service delivery in NHS Wales, Siobhan E. McClelland; GP fundholder admissions and the new NHS, Shelia Ellwood; Relationships in health care commissioning: a case study of Glasgow, Moira Fischbacher and Arthur Francis; Towards more equitable resource allocation to GP practice, Xiao-Ming Huang, Jackie Green, Dick Beath and John E. Clarke; Impact of financial exclusion on health care utilization: is insurance the answer? The case of Kissidougou in rural Guinea-Conarky, Bart Criel, Moussa Sylla, Xavier de Béthune, Mohammed Lamine Yansané, Yéroboye Camara, Sékou Condé and Michel Gody; Supporting purchasing in acute specialists in the Trent region, Nick Payne, Ron Akehurst, Steve Beard, Alan Brennan, Neill Calvert, Jim Chilcott, Chris McCabe, Suzy Paisley and Sue Ward. Economic Evaluation And Its Contribution To Controlling Costs: Is Prevention better than treatment? Implementing evidence-based strategies, Ceri J. Phillips; Cost-effectiveness of alendronate for fracture prevention in postmenopausal women, Jan Jones and David A. Scott; Economic analysis relating to the use of neurological magnetic resonance imaging (MRI), Michael Clark, Ala Szczepura, John Hutton and Joy Fletcher; Evaluating telemedicine support of chronic disease management, Derek G. Cramp, Alastair Morgan, Abdul V. Roudsari and Ewart R. Carson; The cost-effectiveness of economic evaluations, Elisabeth Brock and Mo Malek; Decision analysis: purpose, pitfalls and potential, Manouche Tavakoli, Huw T.O. Davies and Richard Thomson. Concluding Remarks: Strategic issues in health care management - future challenges, Charles Normand.