ABSTRACT
The ultimate objective of health care is improvement in the quality of a patient’s life. Though simple in concept, the achievement of this goal is often difficult to substantiate. Despite health care costs exceeding $988 billion in 1996, the United States ranks only 9th in life expectancy and even lower for infant mortality and other health parameters.[1,2] There is little information available regarding the improvement in quality of life. Reflexively, the government has taken steps to assess the quality of health care in the United States. Congress, in 1989, created the Agency for Health Care Policy and Research and charged it with the responsibility to conduct research to identify effective health care and develop clinical guidelines based upon the findings. The government emphasizes that the outcomes of health care should be evaluated on the basis of factors which directly affect the patient, such as pain and functional ability, rather than on intermediate clinical measures, such as laboratory tests.[3]
Ultimately, the rising cost of health care in the United States will mandate that therapies which fail to directly increase the well-being and productivity of patients be restricted or eliminated, regardless of technical outcome.
