Risk targetting: an approach to cost-containment

The need for rationing in an insurance-based system of health care is inescapable. The best way to tackle the mismatch between demand and supply is, however, not clear. Of the four general strategies described, increasing the risk of disease in a population is shown to be the most effective way of reducing the outcome cost of a service. This may enable health care systems to provide services which would otherwise be unaffordable. This paper develops a technique for assessing risk using Lorenz curves which could be used by health service managers and clinicians. The paper uses cervical cytology screening to illustrate how variables can be selected in such a way as to maximise the number of potential beneficiaries while minimising the number of people to whom the service is offered.