The Target Efficiency of Care—Models and Analyses

Care managers constantly face the question of how best to utilise scarce resources and how to avoid waste of resources. This is especially emphasised in the phrase “increasing needs versus decreasing resources”. However, it is also currently widely agreed that the cost containment does not mean “as cheap as possible” but “achieving the best possible outcomes on available resources”. Therefore, simple productivity measures are insufficient, as service providers, purchasers, governments, clients and customers require value for money also in the terms of quality and effectiveness of interventions. Thus, efficiency is not only a matter of economics, but also involves doing the right things in the right way and in the right time. Central questions are: How effectively the care meets the client’s needs? How efficiently the resources are used and would some alternative way of using them provide with better outcomes? To what extent the available resources are adequate to satisfy the assessed needs? How equal is the resource distribution among the needy groups? It is clear that to be able to answer to these questions is a matter of efficient care management, and moreover, it also helps the managers to defend their resources against cuts or to claim for new resources. Because resources are inevitably limited compared with needs, the use of the resources has to be considered carefully, but the allocation of care cannot be based only on principles of conventional economical efficiency but also on principles of quality and equity. For example Knapp defines efficiency as a combination of equity, economy and effectiveness (Knapp, 1984, 70–81; Vaarama, 1995).