INTRODUCTION

A widespread perception exists in the United States that we use substantial amounts of high cost/low benefit health care and that this is a major factor in the rapid and seemingly inexorable growth of health care costs. Do our health care dollars often buy life-years of poor quality? Who defines such quality? According to what criteria is it defined? These are the questions I shall address in this essay. The first question is, at least in part, an empirical question which must be settled by relevant data. More specifically, what care is in fact utilized in our health care system, at what cost, and with what effects on patients' lives, are all empirical matters of fact, however limited our data on them may be. Whether the effects of particular health care on patients' lives produce life-years of low quality, and whether that health care represents a poor use of scarce economic resources in comparison with other possible uses of the resources, are both evaluative questions which cannot be settled by empirical data alone. While my expertise lies with the evaluative issues, I want to say something first about the empirical issues.

The term “costworthy care” has been coined by Paul Menzel to refer to health care that is worth its true costs to the patient who receives it.