ABSTRACT
Thoseresponsibleforpurchasingorcommissioninghealthservicesarefaced withsomeimportantbutdifficultdecisionsaboutnewinterventions.Currently, thedevelopmentofnewpharmaceuticalproducts,newsurgicaltechniques andnewdiagnosticandimagingtechnologyisproceedingataveryfastrate (Jennet,1992;Hoare,1992).Thelastfewyearshaveseenarateofemergence ofsuchinterventions,eventhoseofwellsubstantiatedclinicaleffectiveness, suchthatthecombinedcostsoftheirpurchasebythehealthservicewould exceedbyseveraltimesanyincreaseinfundingavailable(Snell,1997).Note thatthroughoutthischapterthetermpurchasingisusedfortheprocessby whichHealthAuthoritiesdeterminetheservicestobeprovidedfortheir populations.Inthiscontextitissynonymouswiththetermcommissioning,
whichisnowbecomingmorewidelyused(DepartmentofHealth,1997). Purchasershavenotonlytomakejudgmentsabouttheeffectivenessof
newinterventions,theyalsoneedtomakeassessmentsabouttheircosteffectivenessasanimportantpartofthedecisionabouthowhighapriority eachshouldbegiveninthecompetitionforlimitednewfunds.InmostHealth Authorities,however,thereisalimitednumberofstaffofsufficienttraining andexperiencetoadviseonthesedecisions.Oftenonepublichealthphysician willbereliedontogiveadviceinrespectofalltheacutespecialties.While
It is quite proper that each Health Authority should consider the needs, and therefore the priorities, for treatment and care of the particular population for which it is responsible. That is, the assessment of the importance of a particular intervention is a local decision influenced by local circumstances. By contrast, assessment of the scientific evidence for the effectiveness of an intervention and of its costs is a task which, done properly once, could inform all Health Authorities. Repetition of these assessments by all Health Authorities (or primary care groups) leads to wasteful duplication of effort, poor quality of work, and large numbers of interventions unevaluated in any systematic way.
