Model health care programmes--a possible means to increase the efficiency of health care.

This paper focuses on a specific microlevel mechanism - model health care programmes - to increase the effectiveness and efficiency of health care. To set the scene for such programmes, the paper opens by first making two important points at the macrolevel. First, health improvement competes with other worthy social goals for resources. As deployment of scarce resources is the key political issue, priority setting at the macrolevel is a political process. Second, the choice of specific service is only the last step in a long chain of choices between alternatives. Based on the conviction that a model for providing health services can improve the quality, effectiveness and cost-efficiency of care, the Regional Office for Europe of the World Health Organization has launched a programme entitled model health care programmes and quality assurance of health care. Model health care programmes, first developed on a large scale in Sweden and Finland, can be defined as documented sets of guidelines for the management of a patient with a given problem. The paper reviews the rationale, objectives and contents of such programmes paying special attention to the available evidence on their usefulness. Attention is also drawn to WHO's efforts to develop care programmes for cancer control.