Reduced health care budgets are expected to inhibit the progress in medicine and to lower the quality of medical care. We postulate that these expectations are not justified if decisions in medicine will be based on scientific criteria. Using a clinical scenario we try to describe the difference between true medical progress and application of new techniques. We also try to give reasons for the advantage of differentiation between effectiveness and benefit of medical care. This differentiation leads to a hierarchy of clinical-economic decisions, first on effectiveness and subsequently on efficiency. Effectiveness of medical care is assessed in the dimensions of efficacy, effectiveness, and benefit. Efficiency is assessed in the dimensions of patient’s preference, patient’s compliance, and the relation of costs and consequences. Finally we use three examples to discuss the advantages of these assessments and the possibility of their realization. A necessary condition for this realization is the conceptual change from an effectiveness-oriented medicine to a benefit-oriented one. If we are ready to support future decisions on health care services by solid scientific evidence, we will sooner or later realize the huge gap in and the resulting need for relevant data on health care decisions. This need of investments will bind free resources and will, if adequately directed, lead to a new and large area of services provided by physicians, the setup of a comprehensive health care data base. From these changes in medicine we can expect a reduction in the number of provided services which are characterized either by low effectiveness or by low efficiency (low eff services). This reduction step will be practicable only if its economic component is compensated by other – more effective or more efficient – services. The rewarded setup of a comprehensive health care data base is one of these meaningful and urgently needed possibilities. Following this way it is rather unlikely that progress in medicine will be inhibited; it is rather likely that the necessary resources for financing the progress in medicine will be not bound by low eff services but will really be available to pay for urgently needed information.

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1999
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