[The evaluation of efficacy and efficiency in the health care sector: separate or integrated moments?].

Studies on efficacy (clinical trials) and efficiency (Cost Benefit) in health care are frequently disjoint and carried on by researchers with different background in distinct moments. The origin of this division can be found in the profound conviction existing in the healthcare researchers that efficiency and efficacy are distinct and distant concepts, the former pertaining to the economist, the latter to the clinician. Many are the factors at the basis of this separation which consequently lead to the divergence between the two sector of analysis; among those, probably the most relevant factor is the distinction, in the healthcare sector, between the consumer (the patient) and the purchaser (private and/or public insurance). In reality, the organizational evolution of the health care systems, the consciousness of the interdependency between health and economic benefits, and the progressive shortage of economic resources for the growing healthcare needs, require a major integration of analyses concerning efficacy and efficiency. On this line of thought is moving the operational research where models such as the Data Envelope Analysis and the Semi-Markov Decisional Models have been developed.