Understanding quality and cost from a health policy perspective

The need to make decisions with regard to health-care resource use is a fundamental and central problem of health-care policy. Reasoned health-care policy decisions depend on economic evaluations that enable direct comparison between competing health-care proposals in terms of both cost and quality. The cost-benefit analysis is the most complete way of evaluating the cost and quality of health-care proposals, though this method is costly and requires the assignment of a monetary value to health-care outcomes. The cost-effectiveness analysis, which allows a comparison of health-care proposals in terms of cost and QALYs, is more commonly used. Heretofore, most health policy decisions in the United States have been based on implicit data or analyses of cost and quality. It is impossible, however, to make a reasoned health policy decision without knowing both the cost and the quality of health-care proposals, ideally explicitly. With public health-care quality reporting reaching prominence in the current era, the need for explicit cost and quality data is becoming more and more evident.