Economic approaches to alternative patterns of health care.

There are various approaches to the definition of alternative patterns of health care. One is to consider methods of providing care which differ from those at present being applied. This raises many questions about how care might be delivered, or the techniques of care delivery. Strictly defined, however, the word 'alternative' does not mean 'different' but 'offering a choice of two things'. One important way of viewing this is to consider the choice between doing and not doing, and interpreting the question of choice as simply whether policy Y is worth pursuing or not. When 'alternative' is combined with 'patterns', the issue becomes even broader. Certainly, questions of choice in health care often do relate to how to achieve X or whether to pursue policy Y. But more often the choices to be made are related to how much of A should we be doing and also at what mix of A, B, and C should we be aiming. Thus, there appear to be three interrelated strands of thought in 'alternative patterns of health care': how, whether, and how much of what? The main emphasis of this paper will be on the last question. Posing such questions has certain advantages. Firstly, the questions have parallels in epidemiology. Secondly, economists who consider them would turn to the techniques of cost-effectiveness analysis, cost-benefit analysis, and the use of marginal analysis (this is not a different technique from the first two, but for expository purposes it will be given separate treatment). Some of the problems of measuring costs and benefits will be mentioned, but since Wright (1979) has covered this issue in detail, these problems will not be discussed at length. In addition, the paper will concentrate on ideas and approaches, so no attempt will be made to review the growing amount of published material on cost-benefit and cost-effectiveness studies. Some reference will be made to the approaches of other disciplines but there will be no comprehensive attempt to draw out the similarities to and differences from those approaches and that of this paper.