Management for Doctors: Decision analysis for medical managers

The right decision in this case is not obvious. It is tempting to choose the cheapest programme, but perhaps a slightly more expensive one will produce greater health gain. This itself is difficult to measure, and different programmes do not simply save different numbers of lives. How can we compare prevention of the birth of a baby with Down's syndrome with the birth of a baby with cystic fibrosis? Each programme will also have other "costs": they will cause some miscarriages and make quite a few parents anxious. Typically, managers resolve such conflicts by reference to previous practice and to what others do and by subjectively evaluating the claims of the various pressure groups. The problem with such political methods is that "he who shouts loudest" is likely to win, without necessarily being the most deserving. Sometimes decision makers will want to stand back and attempt a more thoughtful analysis. health care money, would be sensitive to more factors than those which comprise decision analysis,9 but it may not provide the equity which current health care systems seek. Decision analysis is the application to decision making of the reductionist approach that has been so successful elsewhere in science.