Cost-effectiveness in surgery. The insurers' point of view

Cost-effectiveness in surgery is only one example of a global health care policy by the Belgian social insurers aiming at optimal price-quality ratios for the offered care provision and within budgetary constraints. As a main partner in health care management the insurers' decision is guided by socio-economical evaluation of medical technology and care. This evaluation distinguishes respectively cost-benefit (CBA), cost-effectiveness (CEA) and cost-utility (CUA) analyses. In surgery the principles of cost-effective management are illustrated with examples for minor surgery in general practice, one day clinic, tympanostomy tube placement for recurrent otitis media, and laparoscopic vs. laparotomic cholecystectomy. Even if we need economic evaluation for policy making it can only be one instrument for making choices in the increasingly complex and expensive health care sector. To maintain the access, the quality and the actually fair cost-level in Belgium's compulsory health insurance system there is need for standardized indications, clinical guidelines, outcome evaluation and quality assurance by credentialing of providers and service centers.