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Journal of the Academy of Hospital Administration

Vol. 14, No. 1 (2002-01 - 2002-06)


In recent years the proliferation of new techniques and approaches has changed the character of health care remarkably and has affected everyone working in this field.

The rapid spread of high technology health care presents a dilemma to hospital administrators, governing bodies, government agencies and health practitioners. The major difficulty is to know enough about what is going on to be able to take the right long term decisions which involve major capital expenditure.

The decision process is further influenced by different interest groups seeking a larger chunk of the available resources. It is not always necessarily true that funds are insufficient; it may be that the available funds are not being wisely spent.

In deciding whether a service or a newer equipment is medically necessary, the health care providers traditionally focus on the idea that without the particular facility harm would come to the patient or services provided would not be up to the bench mark and that with the facility a potentially beneficial outcome will result. Thus the choice is to be made from one of the two outcomes. However, to make a choice between the two options, the different values and objectives of the providers, recipients and society have a direct bearing.

One learned opinion advocates cost-effectiveness as a basis to arrive at a choice. However, methods applied to define and assess what is and is not cost-effective may also vary. It has been stated that "an intervention is considered cost effective if there is no other available intervention that offers a clinically appropriate benefit at a lower cost". This assessment is also problematic because we rarely know from advance who will benefit from a service and who will not. The assessment is further clouded by the aggressive marketing strategies of the interested sector which influence the consumer making him aware of what is available and raise his expectations.

Where the payers are either the government, employer or any other agency then there is a general tendency to demand the latest, the best and often the costliest.

The dilemma continues. The challenge becomes daunting. Today's manager of health services has to contend with these contradictions and attempt maximum possible level of community satisfaction with appropriate technology.


Editors Signature

A. Chakravarti

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