Evidence-based medicine: Ready for prime time?

Abstract

N b a e M s T T a s v M v c t F nce again, storm clouds are gathring over American medicine. Ination in health care costs, tamed y managed care in the mid-1990s, as reared its head again. The specer of uneven quality and medical istakes, estimated to cost as many s 98,000 lives annually, hangs over he country. And always there is the nrelenting national shame of 43 illion Americans without health nsurance. Some of these same issues suraced in the early 1990s and powred the debate over health care uring the Clinton administration. ven after the demise of the Clinon health plan, economists, busiess leaders, and health policy anaysts thought that they had the nswer: managed care. Managed are would bring market forces to ear in medicine, rationalize medial decision making, and empower onsumers. Of course, for the most art, managed care failed to deliver n these promises, thus bringing us o today’s quandary. So now where do we go? There’s ot much appetite in Washington or a massive federal program such s an expansion of Medicare or edicaid. Market forces may have place at the edges of health care, articularly in controlling costs, ut there is little optimism regardng their role in quality improveent or access. Large employers ave banded together to demand ower costs and better quality. But owadays, providers push back retty hard when pressured on osts, and there remains a stubborn ack of consensus on how to meaure quality, much less improve it. i