Modeling for policy decisions: potential and problems

Because decision modeling involves the construction of an explicit, mathematically describable structure of the pertinent elements of a clinical problem, the relative effectiveness of alternative approaches to care can be identified; costly procedures become apparent; new technologies can be assessed in relation to the old in terms of effectiveness and costs; the marginal benefit to be achieved by duplicative or alternative practices can be determined. All of this can be accomplished in terms of patient outcome and without the bias and self-interest of which the profession has been accused. Furthermore, if a resource allocation or reimbursement decision made in the name of cost containment eliminates or limits access to effective diagnostic or therapeutic technologies, the impact of that decision on effective care can be explicitly and quantitatively expressed through decision modeling. When such analyses are based on patient outcome, they are difficult to ignore and provide a pivotal point for discussions and eventual compromise.