ABSTRACT
This chapter argues that there are real barriers to the application of economic evaluation to decision making that cannot be resolved by increased data collection or methodological refinements. It suggests that health economists should work more closely with decision makers at all levels of the health service in order to understand more clearly the context of the environment in which decisions are made. However, little is known about the influence of such studies on decision making at grassroots level. Evidence to date has suggested that the impact of economic evaluation has not been commensurate with the volume of its literature. Economists commenting on barriers to the use of health economics at local level have tended to highlight the lack of information available to decision makers. These studies showed that forcing decision makers to consider goal conflicts explicitly creates anguish on their part by exposing the gap between the rational ideal and reality.
