[Effectiveness and efficiency: has the time come?]

The different attitude of health professionals and health system administrators towards efficiency and effectiveness reveals an inner health systems tension between the logic of producing and that of caring. This tension entails the risk of dire consequences for universalist health protection systems, as it pushes towards a dissociation in which care relationships are privatized, to safeguard them from the constraints of efficiency, while forms of access inequality are generated. However, efficiency in the production of health does not mean cuts but quality of care and quality in operational choices. It asks clinicians for evidence-based medicine and administrators for a balance sheet valuing health results and not just health services. A health system to effectively serve its scope, must administers effective treatments and only to those people and in those conditions who benefit from it.