Economic aspects of clinical decision making: new perspectives

New perspectives on the economic aspects of clinical decision making in the changing health-care environment are discussed. Economic appraisal of health-care delivery offers a mechanism for categorizing choices, assigning priorities, and consolidating disparate aspects of a problem into common measures, such as the ratio of cost to a desired outcome. While past applications of this technique to health care usually considered only one aspect of patient care at a time, the importance of examining the entire process of patient-care activities and the outcome of that process is now recognized. Clinical decision making should transcend traditional boundaries, such as departments, specialty activities, and institutions. The methods of optimizing health-care outcome must be incorporated into the organization's mission, goals, and reward system. Economic evaluations of clinical decision making should incorporate a framework in which choices are related to desired outcomes and beneficial situations. The challenges lie in defining overall measures of health-care provision and developing management information systems reflecting these patient-care objectives and desired outcomes.