Health Care Management Science 1 (1998) 1–4 1 Towards a science of the management of health care Yasar A. Ozcan a and Peter Smith b a Department of Health Administration, Virginia Commonwealth University, Richmond, VA 23298, USA b Centre for Health Economics, University of York, York YO1 5DD, UK This editorial introduces the new journal and sets out some of the editors’ principles. It notes the apparently haphazard approach towards the improvement in management practice in health care, and contrasts it with the more scientific approach adopted by the medical profession. The journal aims to provide for the first time a single forum for all those engaged in the systematic evaluation of the management of health care, and seeks to nurture a move towards “evidence based management”. We will consider papers from a wide range of institutional settings and disciplinary perspectives. As well as presenting high quality research, authors will be encouraged to make clear the policy implications of their contributions. It is becoming difficult to find any author on health care who does not at some stage express concern at the esca- lation in costs and remorseless growth of the health care sector. Most developed nations have experienced a steady increase in the share of gross domestic product represented by health care, and many have initiated fundamental re- forms in an attempt to moderate that increase. To some extent, the growth of the health care sector is a natural consequence of increased expectations on the demand side, and of new technology and new opportuni- ties on the supply side. The increased demand, at least in industrialized nations, may result from increased wealth. Once basic material needs have been met, societies are in- creasingly likely to turn their attention towards seeking to improve the quality of their lives, most especially through an improvement of their health status. The supply side is driven by a highly profitable health care industry, which, protected by patents, sees the potential for large profits from successful innovations. In these respects health care does not differ from any other growing sector of the econ- omy. The escalation in expenditure on health care is never- theless a cause for concern. First, even with the increased availability of independent advice (for example, via the In- ternet), patients and their families will often remain to some extent ignorant of the nature of their health care needs and the efficacy of treatment. They will therefore continue to rely on the advice of physicians and other health care work- ers, who in many respects can be considered to be the sup- pliers, and whose advice may therefore not always be as dispassionate as patients might wish. Second, in almost all societies the peculiar nature of health care has led to widespread use of social provision and a variety of insur- ance systems. Under these arrangements, it is often the case that neither physician nor patient has an incentive to balance the benefits of treatment against its costs. Both the patient (quite naturally) and the physician (through profes- sional ethic) are prepared to use health care so long as it is perceived to be conferring some benefit on the patient, regardless of costs. These two fundamental considerations – a lack of full information on the part of patients and insensitivity to costs – mean that there are likely to be strong pressures towards an over-supply of health care. Furthermore, checks that the delivery of health care is managerially efficient may be absent. Once again, patients often have neither the in- formation nor the incentive to challenge the way in which their health care is delivered, and until recently insurers (in whatever form) have exhibited notably little interest in efficiency issues. In addition to these efficiency issues, it is also important to note the issues of equitable access to health care and equitable health outcomes, which are of central concern in many health care systems. Concepts of equity have be- come particularly important where there exist limited health care resources, and some rationing or waiting results. In these circumstances it may be the case that perfectly effi- cient managerial solutions may be unacceptable to patients, and can be implemented only if they also satisfy additional criteria relating to fairness. Worldwide, numerous initiatives have been put in place at both strategic and tactical levels in an attempt to ad- dress the problems of inefficiency and inequity in health care. Strategic examples in our own countries have taken the form of managed care (in the US) and a “quasi-market” for health care (in the UK), and parallel policies can be found in almost all developed nations. At the tactical level, countless detailed initiatives intended to address both effi- ciency and equity issues have been tested. Although taking many different forms, and addressing very different aspects of health care, the common theme of all these initiatives is that they require that health care is effectively managed. The purpose of this journal is to demonstrate how rigor- ous research methods can best be deployed to secure that effective management. Even without the unique features noted above, the man- agement of health care would be enormously challenging,  Baltzer Science Publishers BV