Until a few years ago Swiss people, medical doctors included, may have thought that too much treatment was harmless, but too little treatment terrible. It is only in the last few years that ideas about managed care began to grow. Therefore, there does not yet exist a nationwide consensus about the definition of managed care. In a health-care environment that features increasing demand for economic analysis, cost containment and managed care or managed competition, it is only natural that health-care providers should be concerned with preserving their traditional role as advocates of optimal diagnosis and treatment. In the future difficult choices are likely to be disproportionately based on cost analyses, without due consideration to gains in effectiveness. The point of view defended by the Swiss Medical Association is that if rationing of health-care expenditure is to occur, it should be the outcome of an open review based on scientific principles.1 Health-care professionals should be key participants in this process. In order to play this role, they need to improve their skills in the population health sciences, data management and evaluation and the synthesis of evidence-based arguments. We strongly hope to avoid critical health-care decisions’ being made on the basis of political considerations alone, without due reference to the scientific analysis that should inform policy.
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