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The focus of reimbursement in medicine is set to change, the ‘fee for service’ mode will be replaced by one that focuses less on the procedure and more on the evidence behind it. There will be a greater emphasis on demonstrable benefits and/or harms of recommended treatment and will include; a consideration of critical appraisal of evidence, cost-benefit analysis, guideline appraisal, ‘shared risk’ and statistical quality improvement analysis. Justification for specific medical care will have to be supported by substantive evidence of its efficacy and cost effectiveness: the risk/benefit and cost/benefit models. Decision making will no longer be the prerogative of administrator or clinician. Evidence will be ‘king’, the patient will move from passive to active role and will, like any other ‘customer’ demand decision making information based on all the evidence available. The future of medicine will be part of a challenge of individualizing care based on best evidence, clinical judgment and user preferences.

Posted by: zbysfedo - Jun 2003


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