Cost-effectiveness analyses in a changing health care environment: new issues and challenges.

Rising health care expenditures have fuelled the demand for more information about the impact of new medical products on costs and outcomes. Cost-effectiveness analysis (CEA) is one technique used to inform health care decisionmakers. Recent analyses show an increase in the number of CEAs published annually, although study quality remains unchanged. While advances in CEA methodology have been significant, further progress will require changes in the way we conduct basic clinical research, and a greater commitment by groups not usually involved in these analyses.

Effects of teaching on hospital costs.

This study estimates effects of undergraduate and graduate medical education on hospital costs, using a national sample of 367 U.S. community hospitals observed in 1974 and 1977. Data on other cost determinants, such as casemix, allow us to isolate the influence of teaching with greater precision than most previous studies. Non-physician expense in major teaching hospitals is at most 20 percent higher than in non-teaching hospitals; the teaching effect is about half this for hospitals with more limited teaching programs. Results for ancillary service departments are consistent with those for the hospital as a whole.