ABSTRACT
The appropriateness of medical treatment has been an important talking point in the health policy arena for more than three decades. For those concerned to address the seemingly insoluble mismatch between a highly elastic demand for, and a highly inelastic supply of, health care services and treatments, the concept held much promise insofar as it was believed that it might assist in identifying and eliminating waste and inefficiency, thereby enabling scarce resources to be redeployed to more beneficial areas of health care. Indeed, there was initial optimism that development of techniques to evaluate effectiveness might provide a means of avoiding altogether the rationing of health care, in contradistinction to the commonly held belief that such rationing is inevitable. Thus, researchers for the RAND Corporation in the United States, who drew up the first widely accepted appropriateness methodology, 1 expressed the hope that elimination of ‘ineffective’ or ‘unproductive’ care could trim expenditure by one-third with the consequence that ‘explicit rationing or stringent economic measures would not be necessary’. 2
