Intended for healthcare professionals

Bmj Usa: Editorial

Whose health care is more efficient?

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E96
  1. Andrew B Bindman (, professor, department of medicine, epidemiology and biostatistics
  1. Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Building 90, Ward 95, San Francisco, CA 94110

    Fuzzy math obscures comparison of US and UK

    This article originally appeared in BMJ USA

    A longstanding debate in quality improvement has been whether providers need more resources to improve the process and outcomes of care or whether they can achieve these goals by using their resources more efficiently. Political and ethical considerations make it unrealistic to expect a randomized study to resolve the issue, and thus observational studies with comparison groups offer the best alternative. When researchers examine this question in the UK, which has only one system of care (the National Health Service, NHS), the comparison group, by necessity, has to be from another country. One such comparison was published recently by Feachem et al in the BMJ.1 The comparison group they selected for the NHS was the California Kaiser Health Plan, citing similarities in the age of the health systems and the services they provide. (The full text of the study is available at

    The study findings …

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