Management of health services: importance of epidemiology in the year 2000 and beyond.

Abstract

In the last half of the 20th century, remarkable growth occurred in the preventive, diagnostic, treatment, and rehabilitative technologies shown to be efficacious in preventing and treating disease and injury. Management of health care services has become increasingly complex as the scientific basis of health care has grown. Complexity also arises from the multiplicity of decision makers involved in health services (1). Decisions about whether to seek preventive or symptomatic care generally are made by individual persons; the health care provider makes choices about diagnostic, treatment, and rehabilitative options; and, ultimately, the patient is expected to accept the provider's recommendations and to adhere to the prescribed regimen. In the broader context of health care systems, managers must make budget and staffing decisions that affect availability and access to services. Public and private purchasers have become a primary force in cost containment because of their decisions on the scope of coverage provided to their constituencies. Similarly, health insurers have to decide what services are covered, how much to pay for the services, and how much patients will pay out-of-pocket. Also, health insurers increasingly are being held accountable for the quality of care provided to their enrolled populations. These decisions affect access to services and the financial burden of health care on the family. In a perfect world, all decision makers would have access to complete information and could use this information to make best choices for themselves, their patients, and their communities. A central role for epidemiology in health services management is to provide the information needed by patients, providers, managers, insurers, regulators, and policy makers. A major challenge is to provide the information so it can