Growing concern about the financial burden of medical care—on taxpayers, employers, and individuals—has focused attention on the appropriateness and efficiency of clinical strategies. The new Agency for Health Care Policy and Research was established by Congress in 1989 in large part to stimulate and support research that will lead to the development and application of guidelines for effective use of available resources for health. This advice will be aimed in several directions—at payers to guide decisions about which services to cover, at health care systems (eg, hospitals, health maintenance organizations) about which services to make available, and at clinicians and the public about which services to provide and receive.
This trend of analyzing the cost and effectiveness of clinical strategies is an international one. For example, in 1987, the Australian government enacted legislation to require that cost-effectiveness be considered in decisions about which drugs will be included in the National