As health costs in the U.S. soar past $1.5 trillion, much evidence indicates that the nation does not get good value for its
money. It is widely agreed that we could do better by using cost-effective analysis (CEA) to help determine which health
care services are most worthwhile. American policy makers, however, have largely avoided using CEA, and researchers have
devoted little attention to understanding why this is so. By considering the economic, social, legal, and ethical factors
that contribute to the situation, and how they can be negotiated in the future, this book offers a unique perspective. It
traces the roots of EA in health and medicine, describes its promise for rational resource allocation, and discusses the nature
of the opposition to it, using Medicare and the Oregon health plans as examples. In exploring the disconnection between the
promise of CEA and the persistent failure of rational intentions, the book seeks to find common ground and practical solutions.
It analyzes the prospects for change and presents a roadmap for getting there. It offers pragmatic advice for cost-effectiveness
analysts, discussing ways in which they can better translate their research findings into the basis for action. The book
also offers advice for policy makers and politicians, including lessons from Europe, Canada, and Australia, and underlines
the need for leadership to establish the conditions for change.